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Teachey DT, O'Connor D. How I treat newly diagnosed T-cell acute lymphoblastic leukemia and T-cell lymphoblastic lymphoma in children. Blood 2020; 135:159-166. [PMID: 31738819 PMCID: PMC6966932 DOI: 10.1182/blood.2019001557] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 11/14/2019] [Indexed: 12/11/2022] Open
Abstract
T-cell acute lymphoblastic leukemia (T-ALL) is an aggressive malignancy that has historically been associated with a very poor prognosis. Nevertheless, despite a lack of incorporation of novel agents, the development of intensified T-ALL-focused protocols has resulted in significant improvements in outcome in children. Through the use of several representative cases, we highlight the key changes that have driven these advances including asparaginase intensification, the use of induction dexamethasone, and the safe omission of cranial radiotherapy. We discuss the results of recent trials to explore key topics including the implementation of risk stratification with minimal residual disease measurement and how to treat high-risk subtypes such as early T-cell precursor ALL. In particular, we address current discrepancies in treatment between different cooperative groups, including the use of nelarabine, and provide rationales for current treatment protocols for both T-ALL and T-lymphoblastic lymphoma.
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Affiliation(s)
- David T Teachey
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - David O'Connor
- Department of Haematology, University College London (UCL) Cancer Institute, London, United Kingdom; and
- Department of Haematology, Great Ormond Street Hospital for Children, London, United Kingdom
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52
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Gummersall T, Skaczkowski G, Wilson C. Childhood cancer, age at diagnosis and educational attainment: A meta-analysis. Crit Rev Oncol Hematol 2020; 145:102838. [DOI: 10.1016/j.critrevonc.2019.102838] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 10/25/2019] [Accepted: 11/20/2019] [Indexed: 12/23/2022] Open
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53
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Piette C, Suciu S, Bertrand Y, Uyttebroeck A, Vandecruys E, Plat G, Paillard C, Pluchart C, Sirvent N, Maurus R, Poirée M, Simon P, Ferster A, Hoyoux C, Mazingue F, Paulus R, Freycon C, Thomas C, Philippet P, Gilotay C, van der Werff Ten Bosch J, Rohrlich PS, Benoit Y. Long-term outcome evaluation of medium/high risk acute lymphoblastic leukaemia children treated with or without cranial radiotherapy in the EORTC 58832 randomized study. Br J Haematol 2019; 189:351-362. [PMID: 31837008 DOI: 10.1111/bjh.16337] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/23/2019] [Indexed: 01/25/2023]
Abstract
We investigated the long-term outcome, the incidence of second neoplasms (SN) and the rate of late adverse effects (LAE) in children with central nervous system (CNS) negative medium/high-risk de novo acute lymphoblastic leukaemia (ALL), in first complete remission (CR1) at end of late intensification, randomized to receive no cranial radiotherapy (No CRT, n = 92) versus CRT (standard arm, n = 84) in the non-inferiority EORTC 58832 study (1983-1989). Median follow-up was 20 years (range 4-32 years). The 25-year disease-free survival rate (±SE) was 67·4 ± 4·9% without CRT and 70·2 ± 5·0% with CRT. The 25-year incidence of isolated (6·5 ± 2·6% vs. 4·8 ± 2·3%) and any CNS relapse {8·7 ± 2·9% vs. 11·9 ± 3·5%; hazard ratio (HR) 0·71 [95% confidence interval (CI) 0·28-1·79]; test of non-inferiority: P = 0·01} was not increased without CRT. The 25-year SN incidence in CR1 was 7·9 ± 4·6% vs. 11·0 ± 4·2%. The 25-year event-free and overall survival rates were quite similar in both arms [59·5 ± 6·3% vs. 60·5 ± 5·9%, HR 0·94 (95% CI 0·57-1·52), and 78·1 ± 4·3% vs. 78·5 ± 4·5%, HR 1·00 (95% CI 0·53-1·88)]. Omission of CRT was associated with dramatic decrease in CNS and endocrine LAE rates. In conclusion, our data suggest that, with proper systemic and intrathecal CNS prophylaxis, CRT could totally be omitted in CR1 without jeopardizing survival, while decreasing LAE in childhood ALL.
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Affiliation(s)
- Caroline Piette
- Division of Haematology-Oncology, Department of Paediatrics, University Hospital Liège and University of Liège, Liège, Belgium
| | | | - Yves Bertrand
- Department of Paediatric Onco-Haematology, Lyon University Hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Anne Uyttebroeck
- Department of Paediatric Haematology-Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Els Vandecruys
- Department of Paediatric Haematology-Oncology, Ghent University Hospital, Ghent, Belgium
| | - Geneviève Plat
- Department of Paediatric Onco-Haematology, Purpan University Hospital, Toulouse, France
| | - Catherine Paillard
- Department of Haematology, Hautepierre University Hospital, Strasbourg, France
| | - Claire Pluchart
- Department of Paediatric Onco-Haematology, Reims University Hospital, Reims, France
| | - Nicolas Sirvent
- Department of Paediatric Onco-Haematology, Montpellier University Hospital, Montpellier, France
| | - Renée Maurus
- Department of Paediatric Onco-Haematology, Saint-Pierre Hospital, Brussel, Belgium
| | - Maryline Poirée
- Department of Paediatric Onco-Haematology, Nice University Hospital, Nice, France
| | - Pauline Simon
- Department of Paediatric Onco-Haematology, Besançon University Hospital, Besançon, France
| | - Alina Ferster
- Department of Paediatric Onco-Haematology, Hôpital Universitaire des Enfants Reine Fabiola (ULB), Brussels, Belgium
| | - Claire Hoyoux
- Division of Haematology-Oncology, Department of Paediatrics, University Hospital Liège and University of Liège, Liège, Belgium
| | - Françoise Mazingue
- Department of Paediatric Haematology-Oncology, Lille University Hospital, Lille, France
| | | | - Claire Freycon
- Department of Paediatric Onco-Haematology, Grenoble University Hospital, La Tronche, France
| | - Caroline Thomas
- Department of Paediatric Onco-Haematology, Nantes University Hospital, Nantes, France
| | | | | | | | - Pierre S Rohrlich
- Department of Paediatric Onco-Haematology, Nice University Hospital, Nice, France
| | - Yves Benoit
- Department of Paediatric Haematology-Oncology, Ghent University Hospital, Ghent, Belgium
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54
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Jeha S, Pei D, Choi J, Cheng C, Sandlund JT, Coustan-Smith E, Campana D, Inaba H, Rubnitz JE, Ribeiro RC, Gruber TA, Raimondi SC, Khan RB, Yang JJ, Mullighan CG, Downing JR, Evans WE, Relling MV, Pui CH. Improved CNS Control of Childhood Acute Lymphoblastic Leukemia Without Cranial Irradiation: St Jude Total Therapy Study 16. J Clin Oncol 2019; 37:3377-3391. [PMID: 31657981 PMCID: PMC7351342 DOI: 10.1200/jco.19.01692] [Citation(s) in RCA: 156] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2019] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Despite contemporary treatment, up to 10% of children with acute lymphoblastic leukemia still experience relapse. We evaluated whether a higher dosage of PEG-asparaginase and early intensification of triple intrathecal therapy would improve systemic and CNS control. PATIENTS AND METHODS Between 2007 and 2017, 598 consecutive patients age 0 to 18 years received risk-directed chemotherapy without prophylactic cranial irradiation in the St Jude Total Therapy Study 16. Patients were randomly assigned to receive PEG-asparaginase 3,500 U/m2 versus the conventional 2,500 U/m2. Patients presenting features that were associated with increased risk of CNS relapse received two extra doses of intrathecal therapy during the first 2 weeks of remission induction. RESULTS The 5-year event-free survival and overall survival rates for the 598 patients were 88.2% (95% CI, 84.9% to 91.5%) and 94.1% (95% CI, 91.7% to 96.5%), respectively. Cumulative risk of any-isolated or combined-CNS relapse was 1.5% (95% CI, 0.5% to 2.5%). Higher doses of PEG-asparaginase did not affect treatment outcome. T-cell phenotype was the only independent risk factor for any CNS relapse (hazard ratio, 5.15; 95% CI, 1.3 to 20.6; P = . 021). Among 359 patients with features that were associated with increased risk for CNS relapse, the 5-year rate of any CNS relapse was significantly lower than that among 248 patients with the same features treated in the previous Total Therapy Study 15 (1.8% [95% CI, 0.4% to 3.3%] v 5.7% [95% CI, 2.8% to 8.6%]; P = .008). There were no significant differences in the cumulative risk of seizure or infection during induction between patients who did or did not receive the two extra doses of intrathecal treatment. CONCLUSION Higher doses of PEG-asparaginase failed to improve outcome, but additional intrathecal therapy during early induction seemed to contribute to improved CNS control without excessive toxicity for high-risk patients.
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Affiliation(s)
- Sima Jeha
- St Jude Children’s Research Hospital, Memphis, TN
- University of Tennessee Health Science Center, Memphis, TN
| | - Deqing Pei
- St Jude Children’s Research Hospital, Memphis, TN
- University of Tennessee Health Science Center, Memphis, TN
| | - John Choi
- St Jude Children’s Research Hospital, Memphis, TN
- University of Tennessee Health Science Center, Memphis, TN
| | - Cheng Cheng
- St Jude Children’s Research Hospital, Memphis, TN
- University of Tennessee Health Science Center, Memphis, TN
| | - John T. Sandlund
- St Jude Children’s Research Hospital, Memphis, TN
- University of Tennessee Health Science Center, Memphis, TN
| | | | | | - Hiroto Inaba
- St Jude Children’s Research Hospital, Memphis, TN
- University of Tennessee Health Science Center, Memphis, TN
| | - Jeffrey E. Rubnitz
- St Jude Children’s Research Hospital, Memphis, TN
- University of Tennessee Health Science Center, Memphis, TN
| | - Raul C. Ribeiro
- St Jude Children’s Research Hospital, Memphis, TN
- University of Tennessee Health Science Center, Memphis, TN
| | - Tanja A. Gruber
- St Jude Children’s Research Hospital, Memphis, TN
- University of Tennessee Health Science Center, Memphis, TN
| | - Susana C. Raimondi
- St Jude Children’s Research Hospital, Memphis, TN
- University of Tennessee Health Science Center, Memphis, TN
| | - Raja B. Khan
- St Jude Children’s Research Hospital, Memphis, TN
- University of Tennessee Health Science Center, Memphis, TN
| | - Jun J. Yang
- St Jude Children’s Research Hospital, Memphis, TN
- University of Tennessee Health Science Center, Memphis, TN
| | - Charles G. Mullighan
- St Jude Children’s Research Hospital, Memphis, TN
- University of Tennessee Health Science Center, Memphis, TN
| | - James R. Downing
- St Jude Children’s Research Hospital, Memphis, TN
- University of Tennessee Health Science Center, Memphis, TN
| | - William E. Evans
- St Jude Children’s Research Hospital, Memphis, TN
- University of Tennessee Health Science Center, Memphis, TN
| | - Mary V. Relling
- St Jude Children’s Research Hospital, Memphis, TN
- University of Tennessee Health Science Center, Memphis, TN
| | - Ching-Hon Pui
- St Jude Children’s Research Hospital, Memphis, TN
- University of Tennessee Health Science Center, Memphis, TN
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55
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Thastrup M, Marquart HV, Levinsen M, Grell K, Abrahamsson J, Albertsen BK, Frandsen TL, Harila-Saari A, Lähteenmäki PM, Niinimäki R, Pronk CJ, Ulvmoen A, Vaitkevičienė G, Taskinen M, Schmiegelow K, Wehner P, Frost BM, Norén-Nyström U, Behrendtz M, Lund B, Pesola J, Wojcik DM. Flow cytometric detection of leukemic blasts in cerebrospinal fluid predicts risk of relapse in childhood acute lymphoblastic leukemia: a Nordic Society of Pediatric Hematology and Oncology study. Leukemia 2019; 34:336-346. [DOI: 10.1038/s41375-019-0570-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/04/2019] [Accepted: 07/09/2019] [Indexed: 01/30/2023]
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56
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Hofmans M, Suciu S, Ferster A, Van Vlierberghe P, Mazingue F, Sirvent N, Costa V, Yakouben K, Paillard C, Uyttebroeck A, Plantaz D, Plat G, Simon P, Millot F, Poirée M, van der Werff ten Bosch J, Piette C, Minckes O, Rohrlich P, Girard S, Cavé H, Bertrand Y, De Moerloose B. Results of successive EORTC‐CLG 58 881 and 58 951 trials in paediatric T‐cell acute lymphoblastic leukaemia (ALL). Br J Haematol 2019; 186:741-753. [DOI: 10.1111/bjh.15983] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 04/05/2019] [Indexed: 12/30/2022]
Affiliation(s)
- Mattias Hofmans
- Paediatric Haematology‐Oncology and Stem Cell Transplantation Ghent University Hospital GhentBelgium
- Department of Diagnostic Sciences Ghent University GhentBelgium
| | | | - Alina Ferster
- Department of Paediatric Haematology‐Oncology Children's University Hospital Queen FabiolaUniversité Libre de Bruxelles BrusselsBelgium
| | - Pieter Van Vlierberghe
- Cancer Research Institute Ghent GhentBelgium
- Center for Medical Genetics Ghent University Hospital Ghent Belgium
| | - Françoise Mazingue
- Department of Paediatric Haematology‐Oncology Centre Hospitalo‐Universitaire de Lille LilleFrance
| | - Nicolas Sirvent
- Department of Paediatric Haematology‐Oncology Centre Hospitalo‐Universitaire de Montpellier MontpellierFrance
- University Montpellier Montpellier France
| | - Vitor Costa
- Paediatric Department Instituto Português de Oncologia Porto Portugal
| | - Karima Yakouben
- Department of Paediatric Haematology Hôpital Robert DebréAP‐HP ParisFrance
| | - Catherine Paillard
- Department of Paediatric Haematology and Oncology Centre Hospitalo‐Universitaire de Strasbourg Strasbourg France
| | - Anne Uyttebroeck
- Department of Paediatric Haematology‐Oncology University Hospital Gasthuisberg Leuven Belgium
| | - Dominique Plantaz
- Department of Paediatric Oncology University Hospital GrenobleFrance
| | - Geneviève Plat
- Department of Paediatric Haematology‐Oncology Centre Hospitalo‐Universitaire, Hopital Purpan ToulouseFrance
| | - Pauline Simon
- Service Hématologie Oncologie Pédiatrique Centre Hospitalier Régional Universitaire de Besançon BesançonFrance
| | | | - Marilyne Poirée
- Department of Paediatric Haematology‐Oncology Centre Hospitalo‐Universitaire de Nice Nice France
| | | | - Caroline Piette
- Service Universitaire d'Hémato‐Oncologie Pédiatrique Liégeois (SUHOPL)CHR Citadelle Liège Belgium
| | - Odile Minckes
- Department of Paediatric Haematology‐Oncology Centre Hospitalo‐Universitaire de Caen CaenFrance
| | - Pierre Rohrlich
- Department of Paediatric Haematology‐Oncology Centre Hospitalo‐Universitaire de Nice Nice France
| | - Sandrine Girard
- Laboratory of Haematology Institute of Paediatric Haematology and Oncology (IHOP)Hospices Civils de Lyon LyonFrance
| | - Hélène Cavé
- Département de Génétique Assistance Publique des Hôpitaux de Paris (AP‐HP)Hôpital Robert Debré ParisFrance
- INSERM UMR_S1131 Institut de Recherche Saint‐LouisUniversité Paris Diderot ParisFrance
| | - Yves Bertrand
- Institute of Paediatric Haematology and Oncology (IHOP) Haematology UnitHospices Civils de Lyon and Claude Bernard University Lyon France
| | - Barbara De Moerloose
- Paediatric Haematology‐Oncology and Stem Cell Transplantation Ghent University Hospital GhentBelgium
- Cancer Research Institute Ghent GhentBelgium
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57
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Refining risk classification in childhood B acute lymphoblastic leukemia: results of DFCI ALL Consortium Protocol 05-001. Blood Adv 2019; 2:1449-1458. [PMID: 29941458 DOI: 10.1182/bloodadvances.2018016584] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 05/19/2018] [Indexed: 01/11/2023] Open
Abstract
Dana-Farber Cancer Institute (DFCI) ALL Consortium Protocol 05-001 tested a new risk stratification system in children and adolescents with newly diagnosed acute lymphoblastic leukemia (ALL). At study entry, B-ALL patients were classified as standard risk (SR) or high risk (HR) based on age, white blood cell (WBC) count, and central nervous system status. After achieving complete remission (CR), patients with high end-induction minimal residual disease (MRD) (≥10-3 by polymerase chain reaction analysis of patient-specific antigen receptor rearrangements) and/or adverse cytogenetics (KMT2A rearrangement or hypodiploidy) were reclassified as very high risk (VHR) and received intensified therapy. IKZF1 deletion status was retrospectively evaluated by multiplex ligation-dependent probe amplification. Between 2005 and 2011, 678 Philadelphia chromosome-negative B-ALL patients aged 1 to 18 years enrolled; 651 achieved CR and 648 received a final risk group. Among all 678 patients, 5-year event-free survival (EFS) was 87% (95% confidence interval [CI], 84-89) and overall survival 93% (95% CI, 90-94). Five-year disease-free survival of SR patients (N = 407) was 94% (95% CI, 91-96), HR (N = 176) was 84% (95% CI, 77-88), and VHR (N = 65) was 79% (95% CI, 67-87). IKZF1 deletion was present in 62 of 385 (16%) assessed patients and was associated with inferior 5-year EFS (63%; 95% CI, 49%-74% vs 88%; 95% CI, 84%-91%; P < .001), and higher 5-year cumulative incidence of relapse, including among those with low MRD (24% vs 8%, P = .001). In multivariable analysis, age ≥15 years, WBC ≥50 × 109/L, IKZF1 deletion, and MRD ≥10-4 was each associated with inferior outcome. In conclusion, risk-stratified therapy on DFCI 05-001 resulted in favorable outcomes for B-ALL patients, including those with VHR features. IKZF1 deletion was an independent predictor of inferior outcome. This trial was registered at www.clinicaltrials.gov as #NCT00400946.
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58
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Horibe M, Sanui M, Sasaki M, Honda H, Ogura Y, Namiki S, Sawano H, Goto T, Ikeura T, Takeda T, Oda T, Yasuda H, Miyazaki D, Hirose K, Kitamura K, Chiba N, Ozaki T, Yamashita T, Koinuma T, Oshima T, Yamamoto T, Hirota M, Yamamoto S, Oe K, Ito T, Masuda Y, Saito N, Iwasaki E, Kanai T, Mayumi T. Impact of Antimicrobial Prophylaxis for Severe Acute Pancreatitis on the Development of Invasive Candidiasis: A Large Retrospective Multicenter Cohort Study. Pancreas 2019; 48:537-543. [PMID: 30946245 DOI: 10.1097/mpa.0000000000001269] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Antimicrobial prophylaxis is not generally recommended for patients with severe acute pancreatitis (SAP) owing to the limited clinical benefits. Nonetheless, it is frequently administered in actual practice given the patients' critical condition and the lack of solid evidence showing adverse effects of antimicrobial prophylaxis. We evaluated herein an association between antimicrobial prophylaxis and invasive pancreatic candidiasis as an adverse effect in patients with SAP. METHODS This is a retrospective cohort study of all consecutive patients with SAP who were admitted to the study institutions (n = 44) between January 1, 2009, and December 31, 2013. We performed multivariable logistic regression analysis adjusting for the extent of pancreatic necrosis and surgical interventions for invasive pancreatic candidiasis. RESULTS Of the 1097 patients with SAP, 850 (77.5%) received antimicrobial prophylaxis, and 21 (1.9%) had invasive pancreatic candidiasis. In multivariable logistic regression analysis, antimicrobial prophylaxis was significantly associated with the development of invasive pancreatic candidiasis (adjusted odds ratio, 4.23; 95% confidence interval, 1.14-27.6) (P = 0.029). CONCLUSIONS The results suggest that antimicrobial prophylaxis may contribute to the development of invasive pancreatic candidiasis, and therefore, the routine use of antimicrobial prophylaxis for SAP may be discouraged.
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Affiliation(s)
| | - Masamitsu Sanui
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama
| | - Mitsuhito Sasaki
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital
| | - Hitoshi Honda
- Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo
| | - Yuki Ogura
- Department of Gastroenterology and Hepatology, Tokyo Metropolitan Tama Medical Center, Tokyo
| | - Shin Namiki
- Department of Gastroenterology and Hepatology, Tokyo Metropolitan Tama Medical Center, Tokyo
| | - Hirotaka Sawano
- Senri Critical Care Medical Center, Osaka Saiseikai Senri Hospital, Osaka
| | - Takashi Goto
- Department of Anesthesiology and Intensive Care, Hiroshima City Hiroshima Citizens Hospital, Hiroshima
| | - Tsukasa Ikeura
- The Third Department of Internal Medicine, Kansai Medical University, Osaka
| | - Tsuyoshi Takeda
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo
| | - Takuya Oda
- Department of General Internal Medicine, Iizuka Hospital, Fukuoka
| | - Hideto Yasuda
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Musashino Hospital, Tokyo
| | - Dai Miyazaki
- Advanced Emergency Medical and Critical Care Center, Japanese Red Cross Maebashi Hospital, Gunma
| | - Kaoru Hirose
- Department of Emergency Medicine, Shonan Kamakura General Hospital, Kanagawa
| | - Katsuya Kitamura
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine
| | - Nobutaka Chiba
- Department of Emergency and Critical Care Medicine, Nihon University Hospital, Tokyo
| | - Tetsu Ozaki
- Department of Acute Care and General Medicine, Saiseikai Kumamoto Hospital, Kumamoto
| | | | - Toshitaka Koinuma
- Division of Intensive Care, Department of Anesthesiology and Intensive Care Medicine, Jichi Medical University School of Medicine, Tochigi
| | - Taku Oshima
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba
| | - Tomonori Yamamoto
- Department of Traumatology and Critical Care Medicine, Graduate School of Medicine, Osaka City University, Osaka
| | - Morihisa Hirota
- Division of Gastroenterology, Tohoku Medical and Pharmaceutical University, Miyagi
| | - Satoshi Yamamoto
- Department of Gastroenterology, Bantane Hospital, Fujita Health University, Nagoya
| | - Kyoji Oe
- Department of Intensive Care Medicine, Asahi General Hospital, Chiba
| | - Tetsuya Ito
- Department of Medicine, Gastroenterology, Shinshu University School of Medicine, Nagano
| | - Yukiko Masuda
- Emergency and Critical Care Center, National Hospital Organization Nagasaki Medical Center, Nagasaki
| | - Nobuyuki Saito
- Division of Infection Control and Prevention, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba
| | | | | | - Toshihiko Mayumi
- Department of Emergency Medicine, School of Medicine University of Occupational and Environmental Health, Fukuoka, Japan
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59
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Zwicker F, Kirchner C, Huber PE, Debus J, Zwicker H, Klepper R. Breast cancer occurrence after low dose radiotherapy of non-malignant disorders of the shoulder. Sci Rep 2019; 9:5301. [PMID: 30923327 PMCID: PMC6438961 DOI: 10.1038/s41598-019-41725-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 03/14/2019] [Indexed: 11/10/2022] Open
Abstract
Stochastic long-term damages at relatively low doses have the potential for cancer induction. For the first time we investigated the occurrence of breast cancer in female patients after radiotherapy of non-malignant disorders of the shoulder and made a comparison with the estimated spontaneous incidence of mammary carcinoma for this cohort. In a geographically defined district with a population of approximately 100.000 inhabitants, comprehensive data of radiological diagnostics and radiotherapy were registered nearly completely for 41 years; data included mammography and radiotherapy of breast cancer patients as well as of non-malignant disorders. Within this population a collective of 158 women with radiotherapy of the shoulder was investigated. Radiotherapy was performed with cobalt-60 photons (Gammatron) with an average cumulative-dose of 6 Gy. The average follow-up time was 21.3 years. Patients were 55 years old (median) when radiotherapy of the shoulder was performed. Seven patients (4.4%) developed breast cancer after a median of 21 years. According to the incidence statistics, 9.4 +/- 1.8 (95%CI) cases (5.9%) would be expected. In regard to the irradiated shoulder neither the ipsilateral nor the contralateral breasts showed increased rates of breast cancer. An induction of additional breast cancer caused by radiation of non-malignant disorders of the shoulder wasn't detected in the investigated cohort.
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Affiliation(s)
- Felix Zwicker
- Clinical Cooperation Unit Molecular Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
- Clinic and Practice of Radiation Oncology/Practice of Radiology, Konstanz, Germany.
- Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany.
| | - Corinna Kirchner
- Clinic and Practice of Radiation Oncology/Practice of Radiology, Konstanz, Germany
| | - Peter E Huber
- Clinical Cooperation Unit Molecular Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany
| | - Jürgen Debus
- Clinical Cooperation Unit Molecular Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany
| | - Hansjörg Zwicker
- Clinic and Practice of Radiation Oncology/Practice of Radiology, Konstanz, Germany
| | - Rudolf Klepper
- Clinic and Practice of Radiation Oncology/Practice of Radiology, Konstanz, Germany
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Sauter CS, DeFilipp Z, Inamoto Y, Johnston L, Nagler A, Savani BN, Carpenter PA, Perales MA. ASBMT Statement on Routine Prophylaxis for Central Nervous System Recurrence of Acute Lymphoblastic Leukemia following Allogeneic Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2019; 25:e86-e88. [DOI: 10.1016/j.bbmt.2018.12.757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 12/17/2018] [Indexed: 10/27/2022]
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61
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Teachey DT, Pui CH. Comparative features and outcomes between paediatric T-cell and B-cell acute lymphoblastic leukaemia. Lancet Oncol 2019; 20:e142-e154. [PMID: 30842058 PMCID: PMC9233195 DOI: 10.1016/s1470-2045(19)30031-2] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 12/24/2018] [Accepted: 01/02/2019] [Indexed: 01/01/2023]
Abstract
Contemporary paediatric clinical trials have improved 5-year event-free survival above 85% and 5-year overall survival above 90% in B-cell acute lymphoblastic leukaemia (ALL) in many study groups, whilst outcomes for T-cell ALL are still lagging behind by 5-10% in most studies. Several factors have contributed to this discrepant outcome. First, patients with T-cell ALL are generally older than those with B-cell ALL and, therefore, have poorer tolerance to chemotherapy, especially dexamethasone and asparaginase, and have increased risk of extramedullary relapse. Second, a higher proportion of patients with B-cell ALL have favourable genetic subtypes (eg, ETV6-RUNX1 and high hyperdiploidy), which confer a superior outcome compared with favourable subtypes of T-cell ALL. Third, T-cell ALL blasts are generally more resistant to conventional chemotherapeutic drugs than are B-cell ALL blasts. Finally, patients with B-cell ALL are more amendable to available targeted therapies, such as Philadelphia chromosome-positive and some Philadelphia chromosome-like ALL cases to ABL-class tyrosine kinase inhibitors, and CD19-positive and CD22-postive B-cell ALL cases to a variety of immunotherapies. Several novel treatments under investigation might narrow the gap in survival between T-cell ALL and B-cell ALL, although novel treatment options for T-cell ALL are limited.
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Affiliation(s)
- David T Teachey
- Hematology and Oncology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ching-Hon Pui
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA.
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62
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Kinjyo I, Bragin D, Grattan R, Winter SS, Wilson BS. Leukemia-derived exosomes and cytokines pave the way for entry into the brain. J Leukoc Biol 2019; 105:741-753. [PMID: 30702754 DOI: 10.1002/jlb.3a0218-054r] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 12/07/2018] [Accepted: 01/02/2019] [Indexed: 12/25/2022] Open
Abstract
Infiltration of acute lymphoblastic leukemia (ALL) blasts into the CNS remains as a major clinical problem, with high risk for chemotherapy-resistant relapse and treatment-related morbidity. Despite the common inclusion of CNS prophylaxis treatments in therapy regimens, there are significant gaps in understanding the mechanisms that mediate leukemia cell entry into the CNS as well as roles for resident cells in the brain. In this study, we employ a xenograft model of human B cell precursor (BCP)-ALL in immunocompromised mice. This model system recapitulates key pathological characteristics of leptomeningeal involvement seen in patients and provides insights into rare cases that involve parenchymal invasion. We examine the infiltration of engrafted leukemia blasts into brains of recipient mice and provide evidence that the interaction between blasts and brain resident cells causes aberrant activation of host cells in the brain microenvironment. BCP-ALL blasts also release multiple cytokines and exosomes containing IL-15 that bind and are internalized by astrocytes and brain vessel endothelial cells. Leukemic invasion is linked to production of VEGF-AA by astrocytes and disruption of the blood-brain-barrier (BBB) integrity. Knockdown of either IL-15 or IL-15Rα in the NALM6 cell line decreases CNS infiltration in engrafted mice. These results provide important insights into the multiple mechanisms by which lymphoblasts modulate the brain microenvironment to breach the BBB for metastatic invasion.
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Affiliation(s)
- Ichiko Kinjyo
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Denis Bragin
- Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico, USA
| | - Rachel Grattan
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Stuart S Winter
- Blood Diseases and Cancer Program, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, USA
| | - Bridget S Wilson
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA.,Comprehensive Cancer Center, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
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63
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The Impact of Low-Dose Cranial Boost on the Long-Term Outcomes of Adult Patients with High-Risk Acute Lymphoblastic Leukemia Undergoing Total Body Irradiation and Allogeneic Hematopoietic Stem Cell Transplantation. Pract Radiat Oncol 2018; 9:e283-e289. [PMID: 30578956 DOI: 10.1016/j.prro.2018.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/29/2018] [Accepted: 12/12/2018] [Indexed: 11/23/2022]
Abstract
PURPOSE Total body irradiation (TBI) is an integral part of the conditioning regimen for patients with acute lymphoblastic leukemia (ALL) undergoing allogeneic, hematopoietic, cell transplantation (allo-HCT). There are conflicting data in the literature regarding the utility of a cranial irradiation boost in high-risk adult ALL without evidence of preexisting central nervous system (CNS) involvement. This study investigates the posttransplant clinical outcomes of patients with high-risk adult ALL undergoing TBI conditioning for allo-HCT with or without a whole-brain boost, without overt CNS involvement at the time of diagnosis. METHODS AND MATERIALS A retrospective cohort study was conducted using a medical record analysis. We identified 58 patients who were treated between January 1998 and December 2016, and met our preset inclusion criteria of adults (age >18 years old) who carried a pathologically confirmed diagnosis of CNS-negative, high-risk ALL, who underwent hematopoietic stem cell transplantation with TBI conditioning. A multivariate analysis of correlation between patient outcomes and collected categorical variables was assessed with stepwise Cox logistic regression. Survival analyses were assessed using the Kaplan-Meier technique with a log-rank test. RESULTS With a median follow-up time of 5.3 years, there was a statistically significant improvement in actuarial 7-year CNS relapse-free survival (100% vs 76.4%; P = .043) in favor of patients undergoing a cranial boost. There was no statistically significant improvement in 7-year progression-free survival (78.3% vs 62.5%; P = .076) or overall survival (49.4% vs 43.5%; P = .921) with versus without a cranial boost. On multivariate analysis, the presence of a cranial boost was the only identified variable with an independent relationship to CNS relapse-free survival. CONCLUSIONS Adult patients with high-risk, CNS-negative ALL were found to have a statistically significant improvement in CNS relapse-free survival and a trend toward improved progression-free survival with the inclusion of a cranial boost with TBI pretransplant conditioning. Our data indicate that further investigation into the use of cranial boost in this patient population is warranted.
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64
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Cheung LC, Tickner J, Hughes AM, Skut P, Howlett M, Foley B, Oommen J, Wells JE, He B, Singh S, Chua GA, Ford J, Mullighan CG, Kotecha RS, Kees UR. New therapeutic opportunities from dissecting the pre-B leukemia bone marrow microenvironment. Leukemia 2018; 32:2326-2338. [PMID: 29740160 PMCID: PMC6224400 DOI: 10.1038/s41375-018-0144-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 04/03/2018] [Accepted: 04/13/2018] [Indexed: 12/23/2022]
Abstract
The microenvironments of leukemia and cancer are critical for multiple stages of malignancies, and they are an attractive therapeutic target. While skeletal abnormalities are commonly seen in children with acute lymphoblastic leukemia (ALL) prior to initiating osteotoxic therapy, little is known about the alterations to the bone marrow microenvironment during leukemogenesis. Therefore, in this study, we focused on the development of precursor-B cell ALL (pre-B ALL) in an immunocompetent BCR-ABL1+ model. Here we show that hematopoiesis was perturbed, B lymphopoiesis was impaired, collagen production was reduced, and the number of osteoblastic cells was decreased in the bone marrow microenvironment. As previously found in children with ALL, the leukemia-bearing mice exhibited severe bone loss during leukemogenesis. Leukemia cells produced high levels of receptor activator of nuclear factor κB ligand (RANKL), sufficient to cause osteoclast-mediated bone resorption. In vivo administration of zoledronic acid rescued leukemia-induced bone loss, reduced disease burden and prolonged survival in leukemia-bearing mice. Taken together, we provide evidence that targeting leukemia-induced bone loss is a therapeutic strategy for pre-B ALL.
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Affiliation(s)
- Laurence C Cheung
- Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.
- School of Pharmacy and Biomedical Sciences, Curtin University, Perth, WA, Australia.
| | - Jennifer Tickner
- School of Pathology and Laboratory Medicine, University of Western Australia, Perth, WA, Australia
| | - Anastasia M Hughes
- Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Patrycja Skut
- Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Meegan Howlett
- Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Bree Foley
- Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Joyce Oommen
- Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Julia E Wells
- Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Bo He
- Harry Perkins Institute of Medical Research, Centre for Medical Research, University of Western Australia, Perth, WA, Australia
| | - Sajla Singh
- Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Grace-Alyssa Chua
- Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Jette Ford
- Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Charles G Mullighan
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Rishi S Kotecha
- Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
- Department of Haematology and Oncology, Princess Margaret Hospital for Children, Perth, WA, Australia
- School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Ursula R Kees
- Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
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65
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Rhee ES, Kim H, Kang SH, Yoo JW, Koh KN, Im HJ, Seo JJ. Outcome and Prognostic Factors in Pediatric Precursor T-Cell Acute Lymphoblastic Leukemia: A Single-Center Experience. CLINICAL PEDIATRIC HEMATOLOGY-ONCOLOGY 2018. [DOI: 10.15264/cpho.2018.25.2.116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Eun Sang Rhee
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hyery Kim
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sung-Han Kang
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jae Won Yoo
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kyung-Nam Koh
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ho Joon Im
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jong Jin Seo
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Pui CH. To delay or not to delay, that is the question for patients with acute lymphoblastic leukemia who do not receive prophylactic cranial irradiation. Cancer 2018; 124:4442-4446. [PMID: 30303521 DOI: 10.1002/cncr.31756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/06/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Ching-Hon Pui
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
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67
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Yeh T, Liang D, Hou J, Jaing T, Lin D, Yang C, Peng C, Hung I, Lin K, Hsiao C, Jou S, Chiou S, Chen J, Wang S, Chang T, Wu K, Sheen J, Yen H, Chen S, Lu M, Li M, Chang T, Huang T, Chang Y, Chen S, Yang Y, Chang H, Chen B, Lin P, Cheng C, Chao Y, Yang S, Chao YY, Liu H. Treatment of childhood acute lymphoblastic leukemia with delayed first intrathecal therapy and omission of prophylactic cranial irradiation: Results of the TPOG‐ALL‐2002 study. Cancer 2018; 124:4538-4547. [DOI: 10.1002/cncr.31758] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/25/2018] [Accepted: 07/06/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Ting‐Chi Yeh
- Division of Pediatric Hematology‐Oncology Mackay Memorial Hospital and Mackay Medical College Taipei Taiwan
| | - Der‐Cherng Liang
- Division of Pediatric Hematology‐Oncology Mackay Memorial Hospital and Mackay Medical College Taipei Taiwan
| | - Jen‐Yin Hou
- Division of Pediatric Hematology‐Oncology Mackay Memorial Hospital and Mackay Medical College Taipei Taiwan
| | - Tang‐Her Jaing
- Department of Hematology‐Oncology Chang Gung Children’s Hospital–Linkou and Chang Gung University Taoyuan Taiwan
| | - Dong‐Tsamn Lin
- Department of Pediatrics National Taiwan University Hospital, National Taiwan University Taipei Taiwan
| | - Chao‐Ping Yang
- Department of Hematology‐Oncology Chang Gung Children’s Hospital–Linkou and Chang Gung University Taoyuan Taiwan
| | - Ching‐Tien Peng
- Division of Pediatric Hematology and Oncology China Medical University Children’s Hospital Taichung Taiwan
- Department of Biotechnology Asia University Taichung Taiwan
| | - Iou‐Jih Hung
- Department of Hematology‐Oncology Chang Gung Children’s Hospital–Linkou and Chang Gung University Taoyuan Taiwan
| | - Kai‐Hsin Lin
- Department of Pediatrics National Taiwan University Hospital, National Taiwan University Taipei Taiwan
| | - Chih‐Cheng Hsiao
- Department of Pediatrics Chang Gung Memorial Hospital‐Kaohsiung Medical Center, Chang Gung University College of Medicine Kaohsiung Taiwan
| | - Shiann‐Tarng Jou
- Department of Pediatrics National Taiwan University Hospital, National Taiwan University Taipei Taiwan
| | - Shyh‐Shin Chiou
- Department of Pediatrics Kaohsiung Medical University Hospital Kaohsiung Taiwan
| | - Jiann‐Shiuh Chen
- Department of Pediatrics National Cheng Kung University Hospital Tainan Taiwan
| | - Shih‐Chung Wang
- Department of Pediatrics Changhua Christian Hospital Changhua Taiwan
| | - Te‐Kau Chang
- Department of Pediatrics Taichung Veterans General Hospital Taichung Taiwan
| | - Kang‐Hsi Wu
- Division of Pediatric Hematology and Oncology China Medical University Children’s Hospital Taichung Taiwan
| | - Jiunn‐Ming Sheen
- Department of Pediatrics Chang Gung Memorial Hospital‐Kaohsiung Medical Center, Chang Gung University College of Medicine Kaohsiung Taiwan
| | - Hsiu‐Ju Yen
- Department of Pediatrics Taipei Veterans General Hospital and National Yang‐Ming University Taipei Taiwan
| | - Shih‐Hsiang Chen
- Department of Hematology‐Oncology Chang Gung Children’s Hospital–Linkou and Chang Gung University Taoyuan Taiwan
| | - Meng‐Yao Lu
- Department of Pediatrics National Taiwan University Hospital, National Taiwan University Taipei Taiwan
| | - Meng‐Ju Li
- Department of Pediatrics National Taiwan University Hospital, National Taiwan University Taipei Taiwan
- Department of Pediatrics National Taiwan University Hospital Hsin–Chu Branch Hsinchu Taiwan
| | - Tai‐Tsung Chang
- Department of Pediatrics Chia‐Yi Christian Hospital Chiayi Taiwan
| | - Ting‐Huan Huang
- Division of Pediatric Hematology‐Oncology Mackay Memorial Hospital and Mackay Medical College Taipei Taiwan
| | - Yu‐Hsiang Chang
- Department of Pediatrics Kaohsiung Veterans General Hospital Kaohsiung Taiwan
| | - Shu‐Huey Chen
- Department of Pediatrics Taipei Medical University–Shuang Ho Hospital Taipei Taiwan
| | - Yung‐Li Yang
- Department of Pediatrics National Taiwan University Hospital, National Taiwan University Taipei Taiwan
| | - Hsiu‐Hao Chang
- Department of Pediatrics National Taiwan University Hospital, National Taiwan University Taipei Taiwan
| | - Bow‐Wen Chen
- Division of Pediatric Hematology and Oncology Koo Foundation Sun Yat‐Sen Cancer Center Taipei Taiwan
| | - Pei‐Chin Lin
- Department of Pediatrics Kaohsiung Medical University Hospital Kaohsiung Taiwan
| | - Chao‐Neng Cheng
- Department of Pediatrics National Cheng Kung University Hospital Tainan Taiwan
| | - Yu‐Hua Chao
- Department of Pediatrics Chung Shan Medical University Hospital, Chung Shan Medical University Taichung Taiwan
| | - Shang‐Hsien Yang
- Department of Pediatrics Buddhist Tzu Chi General Hospital Hualien Taiwan
| | | | - Hsi‐Che Liu
- Division of Pediatric Hematology‐Oncology Mackay Memorial Hospital and Mackay Medical College Taipei Taiwan
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Kwiecinska K, Strojny W, Pietrys D, Bik-Multanowski M, Siedlar M, Balwierz W, Skoczen S. Late effects in survivors of childhood acute lymphoblastic leukemia in the context of selected gene polymorphisms. Ital J Pediatr 2018; 44:92. [PMID: 30111348 PMCID: PMC6094582 DOI: 10.1186/s13052-018-0526-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 07/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It has been shown that approximately half of survivors of childhood acute lymphoblastic leukemia (ALL) have symptomatic late effects (LE) that may be severe or life-threatening. The aim of our study was to assess the health status of childhood ALL survivors after over 10 years of follow-up and to assess its relationships with gene polymorphisms, numbers and types of LEs, as well as with intensity of chemotherapy and cranial radiotherapy (CRT). METHODS We conducted a telephone survey in 125 ALL survivors (median time from completion of treatment was 12 years) and compared the results with those obtained in our previous study. Most of the patients were followed-up by local providers. RESULTS The prevalence of LEs of approximately 50% was similar in both study groups. More than one LE was found in almost 25% of patients. Endocrine LEs were less frequent than in our previous study (44% vs 22%), probably due to underdiagnosis. The prevalence of hepatitis B/C decreased from 30%/50 to 18% (counted together), and prevalence of neurologic LEs decreased from 18 to 6%. The increase in the rate of second malignancies was not significant (2% vs. 3%). Sixty four percent of patients continued their education at the time of the study. Approximately 51% of ALL survivors who have completed their education by the time of the study had no permanent employment, including 4 mothers of infants and 3 persons qualified for a disability living allowance. These employment problems may have been due to cognitive impairment. The offspring of the ALL survivors included 11 children, all of them healthy. Further analysis showed higher prevalence of hepatitis in patients treated with CRT (p = 0.0001). Genetic studies revealed higher prevalence of hepatitis in patients homozygous for the rs9939609A variant of the FTO gene compared with other patients (p = 0.03). Moreover, wild-type rs1137101 polymorphism (Q223R) of the and leptin receptor gene was more frequent in patients with psychological LEs (p = 0.03). CONCLUSIONS The prevalence of LEs in ALL survivors is of key importance. The transition of childhood ALL survivors from pediatric to adult care should be urgently improved to maintain continued follow-up provide high-quality care. TRIAL REGISTRATION Bioethics Committee of the Jagiellonian University approved the study protocol. Registration number: KBET/113/B/2006.
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Affiliation(s)
- Kinga Kwiecinska
- Department of Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, Wielicka 265, 30-663, Krakow, Poland.
| | - Wojciech Strojny
- Department of Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, Wielicka 265, 30-663, Krakow, Poland
| | - Danuta Pietrys
- Department of Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, Wielicka 265, 30-663, Krakow, Poland
| | - Miroslaw Bik-Multanowski
- Department of Medical Genetics, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Maciej Siedlar
- Department of Clinical Immunology, Chair of Clinical Immunology and Transplantation, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Walentyna Balwierz
- Department of Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, Wielicka 265, 30-663, Krakow, Poland
| | - Szymon Skoczen
- Department of Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, Wielicka 265, 30-663, Krakow, Poland
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69
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Koh K, Kato M, Saito AM, Kada A, Kawasaki H, Okamoto Y, Imamura T, Horibe K, Manabe A. Phase II/III study in children and adolescents with newly diagnosed B-cell precursor acute lymphoblastic leukemia: protocol for a nationwide multicenter trial in Japan. Jpn J Clin Oncol 2018; 48:684-691. [PMID: 29860341 PMCID: PMC6022563 DOI: 10.1093/jjco/hyy071] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 05/07/2018] [Indexed: 11/15/2022] Open
Abstract
B-cell precursor acute lymphoblastic leukemia is the most common pediatric malignancy, but its treatment needs to be modified to cause low acute toxicity and few late complications with a high cure rate. In this trial, we will stratify patients with B-cell precursor acute lymphoblastic leukemia into standard, intermediate and high risk groups according to prognostic factors. In addition, we will establish an evaluation system for minimal residual disease that will enable us to stratify patients based on minimal residual disease in subsequent clinical trials. We will clarify the impact of dexamethasone/vincristine pulse therapy during maintenance therapy in the standard risk group, and intensive l-asparaginase therapy in the intermediate risk group. In the high risk group, usefulness of vincristine intensification will be assessed. This trial has been registered in the UMIN Clinical Trials Registry as UMIN000009339 [http://www.umin.ac.jp/ctr/].
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Affiliation(s)
- Katsuyoshi Koh
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama.,Clinical Research Center, National Hospital Organization Nagoya Medical Center, Aichi
| | - Motohiro Kato
- Children's Cancer Center, National Center for Child Health and Development, Tokyo
| | - Akiko M Saito
- Clinical Research Center, National Hospital Organization Nagoya Medical Center, Aichi
| | - Akiko Kada
- Clinical Research Center, National Hospital Organization Nagoya Medical Center, Aichi
| | | | - Yasuhiro Okamoto
- Department of Pediatrics, Kagoshima University Hospital, Kagoshima
| | - Toshihiko Imamura
- Department of Pediatrics, University Hospital Kyoto Prefectural University of Medicine, Kyoto
| | - Keizo Horibe
- Clinical Research Center, National Hospital Organization Nagoya Medical Center, Aichi
| | - Atsushi Manabe
- Department of Pediatrics, St. Luke's International Hospital, Tokyo, Japan
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70
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Breneman JC, Donaldson SS, Constine L, Merchant T, Marcus K, Paulino AC, Followill D, Mahajan A, Laack N, Esiashvili N, Haas-Kogan D, Laurie F, Olch A, Ulin K, Hodgson D, Yock TI, Terezakis S, Krasin M, Panoff J, Chuba P, Hua CH, Hess CB, Houghton PJ, Wolden S, Buchsbaum J, Fitzgerald TJ, Kalapurakal JA. The Children's Oncology Group Radiation Oncology Discipline: 15 Years of Contributions to the Treatment of Childhood Cancer. Int J Radiat Oncol Biol Phys 2018; 101:860-874. [PMID: 29976498 PMCID: PMC6548440 DOI: 10.1016/j.ijrobp.2018.03.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/31/2018] [Accepted: 03/06/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE Our aim was to review the advances in radiation therapy for the management of pediatric cancers made by the Children's Oncology Group (COG) radiation oncology discipline since its inception in 2000. METHODS AND MATERIALS The various radiation oncology disease site leaders reviewed the contributions and advances in pediatric oncology made through the work of the COG. They have presented outcomes of relevant studies and summarized current treatment policies developed by consensus from experts in the field. RESULTS The indications and techniques for pediatric radiation therapy have evolved considerably over the years for virtually all pediatric tumor types, resulting in improved cure rates together with the potential for decreased treatment-related morbidity and mortality. CONCLUSIONS The COG radiation oncology discipline has made significant contributions toward the treatment of childhood cancer. Our discipline is committed to continuing research to refine and modernize the use of radiation therapy in current and future protocols with the goal of further improving the cure rates and quality of life of children with cancer.
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Affiliation(s)
- John C Breneman
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio.
| | - Sarah S Donaldson
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Louis Constine
- Departments of Radiation Oncology and Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - Thomas Merchant
- Department of Radiation Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Karen Marcus
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Arnold C Paulino
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David Followill
- Imaging and Radiation Oncology Core (IROC) Houston Quality Assurance Center, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Anita Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Nadia Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Natia Esiashvili
- Radiation Oncology Department, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Daphne Haas-Kogan
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Fran Laurie
- Imaging and Radiation Oncology Core (IROC) Rhode Island, Lincoln, Rhode Island
| | - Arthur Olch
- Radiation Oncology Program, Keck School of Medicine, University of Southern California, Los Angeles, California; Children's Hospital Los Angeles, Los Angeles, California
| | - Kenneth Ulin
- Imaging and Radiation Oncology Core (IROC) Rhode Island, Lincoln, Rhode Island; University of Massachusetts, Boston, Massachusetts
| | - David Hodgson
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Pediatric Oncology Group of Ontario, Toronto, Ontario, Canada
| | - Torunn I Yock
- Department of Radiation Oncology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Stephanie Terezakis
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland
| | - Matt Krasin
- Department of Radiation Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
| | | | - Paul Chuba
- Department of Radiation Oncology, St John Hospital and Medical Center, Detroit, Michigan
| | - Chia-Ho Hua
- Department of Radiation Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Clayton B Hess
- Department of Radiation Oncology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Peter J Houghton
- Greehey Children's Cancer Research Institute, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Suzanne Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering, New York, New York
| | | | - Thomas J Fitzgerald
- Imaging and Radiation Oncology Core (IROC) Rhode Island, Lincoln, Rhode Island
| | - John A Kalapurakal
- Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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März M, Meyer S, Erb U, Georgikou C, Horstmann MA, Hetjens S, Weiß C, Fallier-Becker P, Vandenhaute E, Ishikawa H, Schroten H, Dürken M, Karremann M. Pediatric acute lymphoblastic leukemia-Conquering the CNS across the choroid plexus. Leuk Res 2018; 71:47-54. [PMID: 30005184 DOI: 10.1016/j.leukres.2018.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 06/16/2018] [Accepted: 07/02/2018] [Indexed: 12/20/2022]
Abstract
Despite the high prevalence of central nervous system (CNS) involvement in relapsing pediatric acute lymphoblastic leukemia (ALL), our understanding of CNS invasion is still vague. As lymphoblasts have to overcome the physiological blood-CNS barriers to enter the CNS, we investigated the cellular interactions of lymphoblasts with the choroid plexus (CP) epithelium of the blood-cerebrospinal fluid barrier (BCSFB). Both a precurser B cell ALL (pB-ALL) cell line (SD-1) and a T cell ALL (T-ALL) cell line (P12-Ishikawa) were able to actively cross the CP epithelium in a human in vitro model. We could illustrate a transcellular and (supposedly) paracellular transmigration by 3-dimensional immunofluorescence microscopy as well as electron microscopy. Chemotactic stimulation with CXCL12 during this process led to a significantly increased transmigration and blocking CXCL12/CXCR4-signaling by the CXCR4-inhibitor AMD3100 inhibited this effect. However, CXCR4 expression in primary ALL samples did not correlate to CNS disease, indicating that CXCR4-driven CNS invasion across the BCSFB might be a general property of pediatric ALL. Notably, we present a unique in vitro BCSFB model suitable to study CNS invasion of lymphoblasts in a human setting, providing the opportunity to investigate experimental variables, which may determine CNS disease childhood ALL.
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Affiliation(s)
- Martin März
- Department of Pediatrics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Svenja Meyer
- Department of Pediatrics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Ulrike Erb
- Department of Pediatrics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christina Georgikou
- Department of Pediatrics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Martin A Horstmann
- Research Institute Children's Cancer Center and Clinic of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Svetlana Hetjens
- Institute of Medical Statistics and Biomathematics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christel Weiß
- Institute of Medical Statistics and Biomathematics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Petra Fallier-Becker
- Institute of Pathology and Neuropathology, University Hospital of Tuebingen, Tuebingen, Germany
| | - Elodie Vandenhaute
- Laboratoire de la Barrière Hémato-Encéphalique (LBHE, EA 2465), Faculté des Sciences Jean Perrin, Université d'Artois, Lens, France
| | - Hiroshi Ishikawa
- Department of NDU Life Sciences, Nippon Dental University, School of Life Dentistry, Chyoda-ku, Tokyo, Japan
| | - Horst Schroten
- Department of Pediatrics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Matthias Dürken
- Department of Pediatrics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Michael Karremann
- Department of Pediatrics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
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72
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Takahashi H, Kajiwara R, Kato M, Hasegawa D, Tomizawa D, Noguchi Y, Koike K, Toyama D, Yabe H, Kajiwara M, Fujimura J, Sotomatsu M, Ota S, Maeda M, Goto H, Kato Y, Mori T, Inukai T, Shimada H, Fukushima K, Ogawa C, Makimoto A, Fukushima T, Ohki K, Koh K, Kiyokawa N, Manabe A, Ohara A. Treatment outcome of children with acute lymphoblastic leukemia: the Tokyo Children's Cancer Study Group (TCCSG) Study L04-16. Int J Hematol 2018; 108:98-108. [PMID: 29589281 DOI: 10.1007/s12185-018-2440-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 03/22/2018] [Accepted: 03/22/2018] [Indexed: 12/11/2022]
Abstract
The survival rate of children with acute lymphoblastic leukemia (ALL) has increased to approximately 90% after substantial progress in risk-oriented treatment strategies. Between 2005 and 2013, the Tokyo Children's Cancer Study Group (TCCSG) conducted a risk-oriented, non-randomized study, L04-16. The principal aim of this study was to assemble background characteristics and treatment outcomes, and gather genetic information on leukemic cells under central diagnosis. This report outlines the background characteristics and treatment outcomes of 1033 children with ALL treated according to a TCCSG platform. The 5-year event-free and overall survival (OS) rates for all children were 78.1 ± 1.3 and 89.6 ± 1.0%, respectively. The OS rate was significantly higher in children with B-cell precursor (BCP)-ALL (91.9 ± 1.0%, n = 916) than in those with T-ALL (71.9 ± 4.3%, n = 117, p < 0.001). In univariate analysis for BCP-ALL, children aged 1-6 years (5y-OS: 94.2 ± 1.0%), with an initial white blood cell count of < 20,000/μL (94.0 ± 1.0%), high hyperdiploidy (95.4 ± 1.6%), ETV6-RUNX1 (97.4 ± 1.2%) or TCF3-PBX1 (96.9 ± 2.1%), and "Day8NoBlasts" (96.4 ± 1.1%) had the best outcomes. Genetic investigation revealed two novel fusion genes within this cohort: ETV6-ZNF385A and ZNF362-TCF4. Our study highlighted the clinical aspects of genomic features of ALL in Japanese children. We provide fundamental information for the further molecular investigation of this disease.
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Affiliation(s)
- Hiroyuki Takahashi
- Department of Pediatrics, Toho University, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan.
| | - Ryosuke Kajiwara
- Department of Pediatrics, Yokohama City University, Yokohama, Japan
| | - Motohiro Kato
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Daisuke Hasegawa
- Department of Pediatrics, St Luke's International Hospital, Tokyo, Japan
| | - Daisuke Tomizawa
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Yasushi Noguchi
- Department of Pediatrics, Japanese Red Cross Narita Hospital, Narita, Japan
| | - Kazutoshi Koike
- Division of Pediatric Hematology and Oncology, Ibaraki Children's Hospital, Mito, Japan
| | - Daisuke Toyama
- Department of Pediatrics, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Hiromasa Yabe
- Department of Cell Transplantation and Regenerative Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Michiko Kajiwara
- Department of Pediatrics, Tokyo Medical and Dental University, Tokyo, Japan
| | - Junya Fujimura
- Department of Pediatrics, Juntendo University, Tokyo, Japan
| | - Manabu Sotomatsu
- Department of Pediatrics, Gunma Children's Medical Center, Shibukawa, Japan
| | - Setsuo Ota
- Department of Pediatrics, Teikyo University Chiba Medical Center, Ichihara, Japan
| | - Miho Maeda
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Hiroaki Goto
- Division of Hemato-Oncology/Regenerative Medicine, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Yoko Kato
- Department of Pediatrics, Jikei University School of Medicine, Tokyo, Japan
| | - Tetsuya Mori
- Department of Pediatrics, St. Marianna University, Kawasaki, Japan
| | - Takeshi Inukai
- Department of Pediatrics, University of Yamanashi, Chuo, Japan
| | - Hiroyuki Shimada
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Keitaro Fukushima
- Department of Pediatrics, Dokkyo Medical University, Shimotsuga, Japan
| | - Chitose Ogawa
- Department of Pediatric Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Atsushi Makimoto
- Department of Hematology-Oncology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | | | - Kentaro Ohki
- Department of Pediatric Hematology and Oncology Research, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Katsuyoshi Koh
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan
| | - Nobutaka Kiyokawa
- Department of Pediatric Hematology and Oncology Research, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Atsushi Manabe
- Department of Pediatrics, St Luke's International Hospital, Tokyo, Japan
| | - Akira Ohara
- Department of Pediatrics, Toho University, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
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73
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Pinnix CC, Yahalom J, Specht L, Dabaja BS. Radiation in Central Nervous System Leukemia: Guidelines From the International Lymphoma Radiation Oncology Group. Int J Radiat Oncol Biol Phys 2018; 102:53-58. [PMID: 30102203 DOI: 10.1016/j.ijrobp.2018.05.067] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/08/2018] [Accepted: 05/20/2018] [Indexed: 10/14/2022]
Affiliation(s)
- Chelsea C Pinnix
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Joachim Yahalom
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lena Specht
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Bouthaina Shbib Dabaja
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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74
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Millan NC, Pastrana A, Guitter MR, Zubizarreta PA, Monges MS, Felice MS. Acute and sub-acute neurological toxicity in children treated for acute lymphoblastic leukemia. Leuk Res 2018; 65:86-93. [PMID: 29328996 DOI: 10.1016/j.leukres.2017.12.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/23/2017] [Accepted: 12/31/2017] [Indexed: 11/18/2022]
Abstract
Eighty percent of children with acute lymphoblastic leukemia (ALL) survive with current treatments. Neurotoxicity is an infrequent adverse event. We describe clinical presentations of neurological toxicity, phases of treatment when these adverse events were more frequent and patients ́ outcome. From January-1995 to December-2015, 1379 ALL cases were admitted. Neurotoxicity was diagnosed in 49 patients (3.6%) and classified according to neurological syndromes. Medical records, laboratory-tests and images were reviewed. The diagnosed syndromes were: a) Methotrexate-leukoencephalopathy (MLE) (35.4%); b) Cerebral-venous-sinus thrombosis following L-Asparaginase administration (26.5%); c) Vincristine-induced-vocal-cord paralysis (VVCP) (14.2%); d) Stroke-associated vasospasm (14%), after high-dose methotrexate e) Severe polyneuropathy (6.1%); f) Methotrexate myelopathy (2%); and g) Pseudotumor-cerebri (2%) associated with corticosteroid therapy. Neurotoxicity was diagnosed during induction in 55% of cases. We conclude that MLE was the most frequent syndrome. VVCP was observed in infants and Down patients. Seizure was the most common symptom and toxicity occurred mainly during induction phase.
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Affiliation(s)
- Natalia C Millan
- Hematology and Oncology Department, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina.
| | - Analía Pastrana
- Neurology Department, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Myriam R Guitter
- Hematology and Oncology Department, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Pedro A Zubizarreta
- Hematology and Oncology Department, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - María S Monges
- Neurology Department, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - María S Felice
- Hematology and Oncology Department, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
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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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Winick N, Devidas M, Chen S, Maloney K, Larsen E, Mattano L, Borowitz MJ, Carroll A, Gastier-Foster JM, Heerema NA, Willman C, Wood B, Loh ML, Raetz E, Hunger SP, Carroll WL. Impact of Initial CSF Findings on Outcome Among Patients With National Cancer Institute Standard- and High-Risk B-Cell Acute Lymphoblastic Leukemia: A Report From the Children's Oncology Group. J Clin Oncol 2017; 35:2527-2534. [PMID: 28535084 DOI: 10.1200/jco.2016.71.4774] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To determine the prognostic significance of blasts, and of white and red blood cells, in CSF samples at diagnosis of acute lymphoblastic leukemia (ALL), a uniform CSF and risk group classification schema was incorporated into Children's Oncology Group B-cell ALL (B-ALL) clinical trials. Methods CSF status was designated as follows: CNS1, no blasts; CNS2a to 2c, < 5 WBCs/μL and blasts with/without ≥ 10 RBCs/μL or ≥ 5 WBCs/μL plus blasts, with WBCs ≥ 5 times the number of RBCs; CNS3a to 3c, ≥ 5 WBCs/μL plus blasts with/without ≥ 10 RBCs/μL or clinical signs of CNS disease. CNS2 status did not affect therapy; patients with CNS3 status received two extra intrathecal treatments during induction and augmented postinduction therapy with 18 Gy of cranial radiation. Results Among 8,379 evaluable patients enrolled from 2004 to 2010, 7,395 (88.3%) had CNS1 status; 857 (10.2%), CNS2; and 127 (1.5%), CNS3. The 5-year event-free and overall survival rates were, respectively, 85% and 92.7% for CNS1, 76% and 86.8% for CNS2, and 76% and 82.1% for CNS3 ( P < .001). In multivariable analysis that included age, race/ethnicity, initial WBC, and day-29 minimal residual disease < 0.1%, CSF blast, regardless of cell count, was an independent adverse predictor of outcome for patients with standard- or high-risk disease according to National Cancer Institute criteria. The EFS difference reflected a significant difference in the incidence of CNS, not marrow, relapse in patients with CNS1 versus CNS2 and/or CNS3 status. Conclusion Low levels of CNS leukemia, regardless of RBCs, predict inferior outcome and higher rates of CNS relapse. These data suggest that additional augmentation of CNS-directed therapy is warranted for CNS2 disease.
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Affiliation(s)
- Naomi Winick
- Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Kelly Maloney, Children's Hospital Colorado, Aurora, CO; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Leonard Mattano, HARP Pharma Consulting, Mystic, CT; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Andrew Carroll, University of Alabama at Birmingham, AL; Julie M. Gastier-Foster, Institute for Genomic Medicine, Nationwide Children's Hospital; Julie M. Gastier-Foster and Nyla A. Heerema, The Ohio State University School of Medicine, Columbus, OH; Cheryl Willman, University of New Mexico, Albuquerque, NM; Brent Wood, University of Washington, Seattle, WA; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Elizabeth Raetz, University of Utah, Salt Lake City, UT; Stephen P. Hunger, Children's Hospital of Philadelphia, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Meenakshi Devidas
- Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Kelly Maloney, Children's Hospital Colorado, Aurora, CO; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Leonard Mattano, HARP Pharma Consulting, Mystic, CT; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Andrew Carroll, University of Alabama at Birmingham, AL; Julie M. Gastier-Foster, Institute for Genomic Medicine, Nationwide Children's Hospital; Julie M. Gastier-Foster and Nyla A. Heerema, The Ohio State University School of Medicine, Columbus, OH; Cheryl Willman, University of New Mexico, Albuquerque, NM; Brent Wood, University of Washington, Seattle, WA; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Elizabeth Raetz, University of Utah, Salt Lake City, UT; Stephen P. Hunger, Children's Hospital of Philadelphia, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Si Chen
- Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Kelly Maloney, Children's Hospital Colorado, Aurora, CO; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Leonard Mattano, HARP Pharma Consulting, Mystic, CT; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Andrew Carroll, University of Alabama at Birmingham, AL; Julie M. Gastier-Foster, Institute for Genomic Medicine, Nationwide Children's Hospital; Julie M. Gastier-Foster and Nyla A. Heerema, The Ohio State University School of Medicine, Columbus, OH; Cheryl Willman, University of New Mexico, Albuquerque, NM; Brent Wood, University of Washington, Seattle, WA; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Elizabeth Raetz, University of Utah, Salt Lake City, UT; Stephen P. Hunger, Children's Hospital of Philadelphia, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Kelly Maloney
- Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Kelly Maloney, Children's Hospital Colorado, Aurora, CO; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Leonard Mattano, HARP Pharma Consulting, Mystic, CT; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Andrew Carroll, University of Alabama at Birmingham, AL; Julie M. Gastier-Foster, Institute for Genomic Medicine, Nationwide Children's Hospital; Julie M. Gastier-Foster and Nyla A. Heerema, The Ohio State University School of Medicine, Columbus, OH; Cheryl Willman, University of New Mexico, Albuquerque, NM; Brent Wood, University of Washington, Seattle, WA; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Elizabeth Raetz, University of Utah, Salt Lake City, UT; Stephen P. Hunger, Children's Hospital of Philadelphia, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Eric Larsen
- Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Kelly Maloney, Children's Hospital Colorado, Aurora, CO; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Leonard Mattano, HARP Pharma Consulting, Mystic, CT; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Andrew Carroll, University of Alabama at Birmingham, AL; Julie M. Gastier-Foster, Institute for Genomic Medicine, Nationwide Children's Hospital; Julie M. Gastier-Foster and Nyla A. Heerema, The Ohio State University School of Medicine, Columbus, OH; Cheryl Willman, University of New Mexico, Albuquerque, NM; Brent Wood, University of Washington, Seattle, WA; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Elizabeth Raetz, University of Utah, Salt Lake City, UT; Stephen P. Hunger, Children's Hospital of Philadelphia, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Leonard Mattano
- Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Kelly Maloney, Children's Hospital Colorado, Aurora, CO; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Leonard Mattano, HARP Pharma Consulting, Mystic, CT; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Andrew Carroll, University of Alabama at Birmingham, AL; Julie M. Gastier-Foster, Institute for Genomic Medicine, Nationwide Children's Hospital; Julie M. Gastier-Foster and Nyla A. Heerema, The Ohio State University School of Medicine, Columbus, OH; Cheryl Willman, University of New Mexico, Albuquerque, NM; Brent Wood, University of Washington, Seattle, WA; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Elizabeth Raetz, University of Utah, Salt Lake City, UT; Stephen P. Hunger, Children's Hospital of Philadelphia, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Michael J Borowitz
- Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Kelly Maloney, Children's Hospital Colorado, Aurora, CO; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Leonard Mattano, HARP Pharma Consulting, Mystic, CT; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Andrew Carroll, University of Alabama at Birmingham, AL; Julie M. Gastier-Foster, Institute for Genomic Medicine, Nationwide Children's Hospital; Julie M. Gastier-Foster and Nyla A. Heerema, The Ohio State University School of Medicine, Columbus, OH; Cheryl Willman, University of New Mexico, Albuquerque, NM; Brent Wood, University of Washington, Seattle, WA; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Elizabeth Raetz, University of Utah, Salt Lake City, UT; Stephen P. Hunger, Children's Hospital of Philadelphia, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Andrew Carroll
- Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Kelly Maloney, Children's Hospital Colorado, Aurora, CO; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Leonard Mattano, HARP Pharma Consulting, Mystic, CT; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Andrew Carroll, University of Alabama at Birmingham, AL; Julie M. Gastier-Foster, Institute for Genomic Medicine, Nationwide Children's Hospital; Julie M. Gastier-Foster and Nyla A. Heerema, The Ohio State University School of Medicine, Columbus, OH; Cheryl Willman, University of New Mexico, Albuquerque, NM; Brent Wood, University of Washington, Seattle, WA; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Elizabeth Raetz, University of Utah, Salt Lake City, UT; Stephen P. Hunger, Children's Hospital of Philadelphia, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Julie M Gastier-Foster
- Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Kelly Maloney, Children's Hospital Colorado, Aurora, CO; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Leonard Mattano, HARP Pharma Consulting, Mystic, CT; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Andrew Carroll, University of Alabama at Birmingham, AL; Julie M. Gastier-Foster, Institute for Genomic Medicine, Nationwide Children's Hospital; Julie M. Gastier-Foster and Nyla A. Heerema, The Ohio State University School of Medicine, Columbus, OH; Cheryl Willman, University of New Mexico, Albuquerque, NM; Brent Wood, University of Washington, Seattle, WA; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Elizabeth Raetz, University of Utah, Salt Lake City, UT; Stephen P. Hunger, Children's Hospital of Philadelphia, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Nyla A Heerema
- Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Kelly Maloney, Children's Hospital Colorado, Aurora, CO; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Leonard Mattano, HARP Pharma Consulting, Mystic, CT; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Andrew Carroll, University of Alabama at Birmingham, AL; Julie M. Gastier-Foster, Institute for Genomic Medicine, Nationwide Children's Hospital; Julie M. Gastier-Foster and Nyla A. Heerema, The Ohio State University School of Medicine, Columbus, OH; Cheryl Willman, University of New Mexico, Albuquerque, NM; Brent Wood, University of Washington, Seattle, WA; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Elizabeth Raetz, University of Utah, Salt Lake City, UT; Stephen P. Hunger, Children's Hospital of Philadelphia, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Cheryl Willman
- Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Kelly Maloney, Children's Hospital Colorado, Aurora, CO; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Leonard Mattano, HARP Pharma Consulting, Mystic, CT; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Andrew Carroll, University of Alabama at Birmingham, AL; Julie M. Gastier-Foster, Institute for Genomic Medicine, Nationwide Children's Hospital; Julie M. Gastier-Foster and Nyla A. Heerema, The Ohio State University School of Medicine, Columbus, OH; Cheryl Willman, University of New Mexico, Albuquerque, NM; Brent Wood, University of Washington, Seattle, WA; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Elizabeth Raetz, University of Utah, Salt Lake City, UT; Stephen P. Hunger, Children's Hospital of Philadelphia, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Brent Wood
- Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Kelly Maloney, Children's Hospital Colorado, Aurora, CO; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Leonard Mattano, HARP Pharma Consulting, Mystic, CT; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Andrew Carroll, University of Alabama at Birmingham, AL; Julie M. Gastier-Foster, Institute for Genomic Medicine, Nationwide Children's Hospital; Julie M. Gastier-Foster and Nyla A. Heerema, The Ohio State University School of Medicine, Columbus, OH; Cheryl Willman, University of New Mexico, Albuquerque, NM; Brent Wood, University of Washington, Seattle, WA; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Elizabeth Raetz, University of Utah, Salt Lake City, UT; Stephen P. Hunger, Children's Hospital of Philadelphia, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Mignon L Loh
- Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Kelly Maloney, Children's Hospital Colorado, Aurora, CO; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Leonard Mattano, HARP Pharma Consulting, Mystic, CT; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Andrew Carroll, University of Alabama at Birmingham, AL; Julie M. Gastier-Foster, Institute for Genomic Medicine, Nationwide Children's Hospital; Julie M. Gastier-Foster and Nyla A. Heerema, The Ohio State University School of Medicine, Columbus, OH; Cheryl Willman, University of New Mexico, Albuquerque, NM; Brent Wood, University of Washington, Seattle, WA; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Elizabeth Raetz, University of Utah, Salt Lake City, UT; Stephen P. Hunger, Children's Hospital of Philadelphia, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Elizabeth Raetz
- Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Kelly Maloney, Children's Hospital Colorado, Aurora, CO; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Leonard Mattano, HARP Pharma Consulting, Mystic, CT; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Andrew Carroll, University of Alabama at Birmingham, AL; Julie M. Gastier-Foster, Institute for Genomic Medicine, Nationwide Children's Hospital; Julie M. Gastier-Foster and Nyla A. Heerema, The Ohio State University School of Medicine, Columbus, OH; Cheryl Willman, University of New Mexico, Albuquerque, NM; Brent Wood, University of Washington, Seattle, WA; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Elizabeth Raetz, University of Utah, Salt Lake City, UT; Stephen P. Hunger, Children's Hospital of Philadelphia, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Stephen P Hunger
- Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Kelly Maloney, Children's Hospital Colorado, Aurora, CO; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Leonard Mattano, HARP Pharma Consulting, Mystic, CT; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Andrew Carroll, University of Alabama at Birmingham, AL; Julie M. Gastier-Foster, Institute for Genomic Medicine, Nationwide Children's Hospital; Julie M. Gastier-Foster and Nyla A. Heerema, The Ohio State University School of Medicine, Columbus, OH; Cheryl Willman, University of New Mexico, Albuquerque, NM; Brent Wood, University of Washington, Seattle, WA; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Elizabeth Raetz, University of Utah, Salt Lake City, UT; Stephen P. Hunger, Children's Hospital of Philadelphia, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - William L Carroll
- Naomi Winick, University of Texas Southwestern Medical Center, Dallas, TX; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Kelly Maloney, Children's Hospital Colorado, Aurora, CO; Eric Larsen, Maine Children's Cancer Program, Scarborough, ME; Leonard Mattano, HARP Pharma Consulting, Mystic, CT; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Andrew Carroll, University of Alabama at Birmingham, AL; Julie M. Gastier-Foster, Institute for Genomic Medicine, Nationwide Children's Hospital; Julie M. Gastier-Foster and Nyla A. Heerema, The Ohio State University School of Medicine, Columbus, OH; Cheryl Willman, University of New Mexico, Albuquerque, NM; Brent Wood, University of Washington, Seattle, WA; Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Elizabeth Raetz, University of Utah, Salt Lake City, UT; Stephen P. Hunger, Children's Hospital of Philadelphia, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
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77
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Gossai NP, Gordon PM. The Role of the Central Nervous System Microenvironment in Pediatric Acute Lymphoblastic Leukemia. Front Pediatr 2017; 5:90. [PMID: 28491865 PMCID: PMC5405081 DOI: 10.3389/fped.2017.00090] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 04/10/2017] [Indexed: 12/11/2022] Open
Abstract
Acute lymphoblastic leukemia (ALL) is the most common cancer in children. While survival rates for ALL have improved, central nervous system (CNS) relapse remains a significant cause of treatment failure and treatment-related morbidity. Accordingly, there is a need to identify more efficacious and less toxic CNS-directed leukemia therapies. Extensive research has demonstrated a critical role of the bone marrow (BM) microenvironment in leukemia development, maintenance, and chemoresistance. Moreover, therapies to disrupt mechanisms of BM microenvironment-mediated leukemia survival and chemoresistance represent new, promising approaches to cancer therapy. However, in direct contrast to the extensive knowledge of the BM microenvironment, the unique attributes of the CNS microenvironment that serve to make it a leukemia reservoir are not yet elucidated. Recent work has begun to define both the mechanisms by which leukemia cells migrate into the CNS and how components of the CNS influence leukemia biology to enhance survival, chemoresistance, and ultimately relapse. In addition to providing new insight into CNS relapse and leukemia biology, this area of investigation will potentially identify targetable mechanisms of leukemia chemoresistance and self-renewal unique to the CNS environment that will enhance both the durability and quality of the cure for ALL patients.
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Affiliation(s)
- Nathan P Gossai
- Division of Pediatric Hematology and Oncology, University of Minnesota, Minneapolis, MN, USA
| | - Peter M Gordon
- Division of Pediatric Hematology and Oncology, University of Minnesota, Minneapolis, MN, USA.,University of Minnesota Masonic Cancer Center, Minneapolis, MN, USA
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78
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Ranta S, Palomäki M, Levinsen M, Taskinen M, Abrahamsson J, Mellgren K, Niinimäki R, Schmiegelow K, Heyman M, Harila-Saari A. Role of neuroimaging in children with acute lymphoblastic leukemia and central nervous system involvement at diagnosis. Pediatr Blood Cancer 2017; 64:64-70. [PMID: 27555087 DOI: 10.1002/pbc.26182] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 07/09/2016] [Accepted: 07/12/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Each year approximately 200 children and adolescents are diagnosed with acute lymphoblastic leukemia (ALL) in the five Nordic countries, and 3% of these have central nervous system (CNS) involvement confirmed by leukemic cells in the cerebrospinal fluid (CSF) or neurological symptoms. We sought to determine the significance of neuraxis imaging in such patients. PROCEDURE Magnetic resonance images of children aged 1-17.9 with CNS leukemia at diagnosis of ALL were centrally reviewed and clinical data were retrieved from the medical records and the Nordic leukemia registry. Patients were diagnosed in the period 2000-2012 in Sweden, Finland, or Denmark. RESULTS The cohort comprised 1,877 patients, and 66 (3.5%) had CNS involvement. Forty-five percent (30/66) had CNS related symptoms. Symptoms included vomiting, facial palsy, headache, visual symptoms, and impaired hearing. CNS imaging was performed in 32 of 66 children (48%), and confirmed CNS involvement in 6 of 21 patients with symptoms (29%) and 5 of 11 (45%) without (P = 0.44). There was no difference in the overall survival between CNS-positive patients with and without signs of leukemic involvement by imaging (P = 0.53). CONCLUSIONS Radiological imaging of asymptomatic children with CNS leukemia at diagnosis lacks clinical importance, but may be useful in patients with cranial nerve symptoms and negative CSF, as well as for follow-up. Imaging of symptomatic patients is warranted in order to exclude other causes underlying the symptoms.
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Affiliation(s)
- Susanna Ranta
- Astrid Lindgren Children's Hospital, Karolinska University Hospital and Department of Women's and Children's Health, Childhood Cancer Research Unit, Karolinska Institutet, Stockholm, Sweden
| | - Maarit Palomäki
- Department of Radiology, Helsinki University Hospital, Helsinki, Finland
| | - Mette Levinsen
- Department of Paediatrics and Adolescent Medicine, The University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Mervi Taskinen
- Children and Adolescents Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Jonas Abrahamsson
- Department of Pediatrics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Karin Mellgren
- Department of Pediatrics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Riitta Niinimäki
- Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
| | - Kjeld Schmiegelow
- Department of Paediatrics and Adolescent Medicine, The University Hospital Rigshospitalet, Copenhagen, Denmark.,Faculty of Medicine, The Institute of Gynecology, Obstetrics, and Pediatrics, University of Copenhagen, Denmark
| | - Mats Heyman
- Astrid Lindgren Children's Hospital, Karolinska University Hospital and Department of Women's and Children's Health, Childhood Cancer Research Unit, Karolinska Institutet, Stockholm, Sweden
| | - Arja Harila-Saari
- Astrid Lindgren Children's Hospital, Karolinska University Hospital and Department of Women's and Children's Health, Childhood Cancer Research Unit, Karolinska Institutet, Stockholm, Sweden
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79
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Inaba H, Azzato EM, Mullighan CG. Integration of Next-Generation Sequencing to Treat Acute Lymphoblastic Leukemia with Targetable Lesions: The St. Jude Children's Research Hospital Approach. Front Pediatr 2017; 5:258. [PMID: 29255701 PMCID: PMC5722984 DOI: 10.3389/fped.2017.00258] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 11/20/2017] [Indexed: 12/16/2022] Open
Abstract
Acute lymphoblastic leukemia (ALL) is the most common type of cancer in children. In recent Total Therapy studies conducted at St. Jude Children's Research Hospital, children with ALL had a 5-year overall survival of around 94%. This is the result of a combination of risk stratification based on the biological features of the leukemic cells and the response to treatment (as assessed by the detection of minimal residual disease), treatment modification based on pharmacodynamic and pharmacogenomic data, and improved supportive care. However, innovative approaches are required to further improve survival to as close to 100% as possible and to reduce the adverse effects of treatment. Next-generation sequencing of leukemic cell DNA and RNA, as well as of germline DNA, can identify submicroscopic genetic structural changes and sequence alterations that contribute to leukemogenesis. Next-generation sequencing data can be used to define new ALL subtypes, to help improve treatment response and reduce adverse effects, and to identify novel prognostic markers and therapeutic targets to facilitate personalized precision medicine. In this article, we describe our approach to detecting targetable lesions in patients with ALL by next-generation sequencing and explain how we integrate the sequencing data into the treatment of these patients.
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Affiliation(s)
- Hiroto Inaba
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Elizabeth M Azzato
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Charles G Mullighan
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, United States
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80
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Abstract
Acute lymphoblastic leukemia (ALL) is the most common malignancy in childhood. Despite enormous improvement of prognosis during the last half century, ALL remains a major cause of childhood cancer-related mortality. During the past decade, whole genomic methods have enhanced our knowledge of disease biology. Stratification of therapy according to early treatment response measured by minimal residual disease allows risk group assignment into different treatment arms, ranging from reduction to intensification of treatment. Progress has been achieved in academic clinical trials by optimization of combined chemotherapy, which continues to be the mainstay of contemporary treatment. The availability of suitable volunteer main histocompatibility antigen-matched unrelated donors has increased the rates of hematopoietic stem cell transplantation (HSCT) over the past two decades. Allogeneic HSCT has become an alternative treatment for selected, very-high-risk patients. However, intensive treatment burdens children with severe acute toxic effects that can cause permanent organ damage and even toxic death. Immunotherapeutic approaches have recently come to the forefront in ALL therapy. Monoclonal antibodies blinatumomab and inotuzumab ozogamicin as well as gene-modified T cells directed to specific target antigens have shown efficacy against resistant/relapsed leukemia in phase I/II studies. Integration of these newer modalities into combined regimens with chemotherapy may rescue a subset of children not curable by contemporary therapy. Another major challenge will be to incorporate less toxic regimens into the therapy of patients with low-risk disease who have a nearly 100% chance of being cured, and the ultimate goal is to improve their quality of life while maintaining a high cure rate.
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Affiliation(s)
- Jan Starý
- Department of Pediatric Hematology and Oncology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Ondřej Hrušák
- Department of Pediatric Hematology and Oncology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
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81
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Frishman-Levy L, Izraeli S. Advances in understanding the pathogenesis of CNS acute lymphoblastic leukaemia and potential for therapy. Br J Haematol 2016; 176:157-167. [DOI: 10.1111/bjh.14411] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 08/15/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Liron Frishman-Levy
- Childhood Leukaemia Research Section; Department of Paediatric Oncology and the Cancer Research Centre; Safra Children Hospital and Sheba Medical Centre; Tel Hashomer Ramat Gan Israel
- Department of Human Genetics and Biochemistry; Tel Aviv University; Tel Aviv Israel
| | - Shai Izraeli
- Childhood Leukaemia Research Section; Department of Paediatric Oncology and the Cancer Research Centre; Safra Children Hospital and Sheba Medical Centre; Tel Hashomer Ramat Gan Israel
- Department of Human Genetics and Biochemistry; Tel Aviv University; Tel Aviv Israel
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82
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Clinical impact of minimal residual disease in children with different subtypes of acute lymphoblastic leukemia treated with Response-Adapted therapy. Leukemia 2016; 31:333-339. [PMID: 27560110 PMCID: PMC5288281 DOI: 10.1038/leu.2016.234] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 07/26/2016] [Accepted: 08/04/2016] [Indexed: 01/01/2023]
Abstract
To determine the clinical significance of minimal residual disease (MRD) in patients with prognostically relevant subtypes of childhood acute lymphoblastic leukemia (ALL), we analyzed data from 488 patients treated in St Jude Total Therapy Study XV with treatment intensity based mainly on MRD levels measured during remission induction. MRD levels on day 19 predicted treatment outcome for patients with hyperdiploid >50 ALL, National Cancer Institute (NCI) standard-risk B-ALL or T-cell ALL, while MRD levels on day 46 were prognostic for patients with NCI standard-risk or high-risk B-ALL. Patients with t(12;21)/(ETV6-RUNX1) or hyperdiploidy >50 ALL had the best prognosis; those with a negative MRD on day 19 had a particularly low risk of relapse: 1.9% and 3.8%, respectively. Patients with NCI high-risk B-ALL or T-cell ALL had an inferior outcome; even with undetectable MRD on day 46, cumulative risk of relapse was 12.7% and 15.5%, respectively. Among patients with NCI standard-risk B-ALL, the outcome was intermediate overall but was poor if MRD was ⩾1% on day 19 or MRD was detectable at any level on day 46. Our results indicate that the clinical impact of MRD on treatment outcome in childhood ALL varies considerably according to leukemia subtype and time of measurement.
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83
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Vrooman LM, Silverman LB. Treatment of Childhood Acute Lymphoblastic Leukemia: Prognostic Factors and Clinical Advances. Curr Hematol Malig Rep 2016; 11:385-94. [DOI: 10.1007/s11899-016-0337-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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84
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Tang A, Alyman C, Anderson L, Hodson DI, Marjerrison S. Long-Term Social Outcomes of Hyperfractionated Radiation on Childhood ALL Survivors. Pediatr Blood Cancer 2016; 63:1445-50. [PMID: 27100384 DOI: 10.1002/pbc.26027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 03/28/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND/OBJECTIVES Childhood cranial radiation has irreversible neurocognitive effects. Hyperfractionated radiation therapy (HFX) for acute lymphoblastic leukemia (ALL) was randomized against conventionally fractionated radiation therapy (CFX) in the DFCI 87-01/91-01 trials attempting to minimize these effects. When neurocognitive testing 8-year posttreatment demonstrated no difference, this strategy was abandoned. The objective of this study was to evaluate late social outcomes among patients who received HFX compared to CFX as part of the DFCI 87-01/91-01 trials. METHODS This retrospective chart review examined all patients treated according to the DFCI 87-01/91-01 trials at the McMaster Children's Hospital in Hamilton, Canada. Patients <18 years at diagnosis and who have attended follow-up clinic since January 1, 2000 were included in this study. Social outcomes and IQ test results were examined for trends. Demographics and outcomes were presented with descriptive statistics. RESULTS We identified 57 DFCI 87-01/91-01 trial participants: 14 received HFX, 29 received CFX, and 14 received no radiation. There were no demographic differences between the groups. HFX survivors were more likely to be living independently (64% vs. 28%, P = 0.02) and engaged in long-term relationships (57% vs. 25%, P = 0.04) than CFX. Nonsignificant trends suggested that HFX survivors may be more financially independent, employed full-time, had fewer educational difficulties in school, and higher scores on neuropsychological testing. Data trends, although not significant, persisted in logistic regression analysis when accounting for age. CONCLUSION Long-term social outcomes were better among ALL survivors who received HFX than CFX. A wider study involving all patients enrolled on DFCI 87-01/91-01 protocols should be conducted to reconsider radiation protocols for ALL.
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Affiliation(s)
- Andrea Tang
- Department of Science, McMaster University, Hamilton, Ontario, Canada
| | - Cheryl Alyman
- Division of Hematology/Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada.,Division of Psychiatry, McMaster University, Hamilton, Ontario, Canada
| | - Loretta Anderson
- Division of Hematology/Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - D Ian Hodson
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada.,Division of Radiation Oncology, Juravinski Cancer Centre, Hamilton, Ontario, Canada
| | - Stacey Marjerrison
- Division of Hematology/Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada.,Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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85
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Su W, Thompson M, Sheu RD, Steinberg A, Isola L, Stock R, Bakst RL. Low-dose cranial boost in high-risk adult acute lymphoblastic leukemia patients undergoing bone marrow transplant. Pract Radiat Oncol 2016; 7:103-108. [PMID: 28274393 DOI: 10.1016/j.prro.2016.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/07/2016] [Accepted: 06/19/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Acute lymphoblastic leukemia (ALL) has a predilection for CNS involvement. Patients with high-risk ALL are often managed with transplant using a radiation-based conditioning regimen. Historically, a high-dose prophylactic cranial boost (CB) of ≥12 Gy was given to reduce risk of central nervous system (CNS) recurrence. However, the use of CB has fallen out of favor because of toxicity concerns. In high-risk adults undergoing transplant at our institution, we have used a low-dose 6 Gy CB to reduce toxicity while conditioning adults with fully developed brains. The safety, efficacy, and utility of a low-dose CB in adults are poorly studied; herein, we report their outcomes and toxicity. METHODS AND MATERIALS We identified all high-risk ALL patients undergoing total body irradiation as part of their conditioning regimen. Those who received 6 Gy CB or no CB were included (55 total). Their charts were reviewed and statistical analyses were completed with R, version 2.15.2. RESULTS In patients undergoing CB, 3-year CNS disease-free survival and overall survival were 94.7% and 62.7%. In those not undergoing CBs, survivals were 81.8% and 51.5%. Notably, within the CB cohort, patients without prior CNS involvement had no CNS failures. In contrast, in the non-CB cohort, there were 2 CNS failures in patients with no history of CNS involvement. In the CB cohort, the only notable acute toxicity was parotitis (2.8%). Late toxicity in the CB cohort included 1 instance of cataracts (2.8%) without any evidence of cognitive impairment or potential radiation induced secondary malignancy. CONCLUSIONS A dose of 6 Gy CB is well-tolerated in the adult ALL population as part of a radiation-based conditioning regimen. Low-dose CB may be considered in adult patients with high-risk ALL without prior CNS involvement to reduce the likelihood of recurrence.
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Affiliation(s)
- William Su
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marcher Thompson
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ren-Dih Sheu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Amir Steinberg
- Department of Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Luis Isola
- Department of Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Richard Stock
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Richard L Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York.
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