1
|
Zhu S, Cheng Z, Wu Z, Liang Q, Chen S, Zhang J, Chen Z, Lin F, Chen Y, Wang J. The Association Between Socioeconomic Factors at Diagnosis and Survival in Medulloblastoma: A Propensity Score-Matched Analysis and Population-Based Study. J Racial Ethn Health Disparities 2024; 11:1843-1856. [PMID: 37548855 DOI: 10.1007/s40615-023-01656-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 04/05/2023] [Accepted: 05/24/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Medulloblastoma (MB) is the most common malignant brain tumor of childhood. The associations between socioeconomic statuses (SES) and survival outcomes of medulloblastoma remain unclear. The aim of this study was to develop a nomogram to predict medulloblastoma specific death (MBSD) and overall survival (OS) in patients with medulloblastoma, taking into account socioeconomic factors in patients with medulloblastoma. METHODS We included patients diagnosed with MB between 1975 and 2016 from the Surveillance, Epidemiology, and End Results database. Propensity Score Matching (PSM) was performed to reduce selection bias. Multivariate cox proportional hazards model was used to assess SES impact and clinically relevant variables of medulloblastoma specific death and overall survival. Independent prognostic factors determined by multivariate analysis were used to construct nomograms. RESULTS A total of 2660 patients were enrolled after matching. Study showed unemployed rate (MBSD, high level vs. low level, P = 0.020) (OS, high level vs. low level, P = 0.017), and marital status (OS, married vs unmarried/unknown, P = 0.029) were important factors affecting prognosis of medulloblastoma in male. Meanwhile, median household income (MBSD, quartile 1 vs. quartile 3, P = 0.047) (OS, quartile 1 vs. quartile 2, P = 0.017) (OS, quartile 1 vs. quartile 3, P = 0.014), residence (MBSD, urban vs. rural, P = 0.041), and insurance status (MBSD, insured vs. uninsured/unknown, P = 0.002)(OS, insured vs. uninsured/unknown, P = 0.001) were significant factors affecting prognosis of medulloblastoma in female. Through the calibration plot and C-index test, our nomogram was also of predictive significance. CONCLUSIONS The unique features of MB have provided a scenario for analysis of the impact of racial, ethnic, gender, and socioeconomic factors. The current findings have important public health implications for achieving the goal of a healthy population. Given the known morbidity rates, long-term psychological, financial and medical burdens that these children and their families must bear, it is critical to identify and address these gaps.
Collapse
Affiliation(s)
- Sihan Zhu
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Zhuqing Cheng
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Zuqing Wu
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Qiangtian Liang
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Siyu Chen
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Ji Zhang
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Zhenghe Chen
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Fuhua Lin
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China.
| | - Yinsheng Chen
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China.
| | - Jian Wang
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China.
| |
Collapse
|
2
|
Patel H, Shah H, Patel G, Patel A. Hematologic cancer diagnosis and classification using machine and deep learning: State-of-the-art techniques and emerging research directives. Artif Intell Med 2024; 152:102883. [PMID: 38657439 DOI: 10.1016/j.artmed.2024.102883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 04/16/2024] [Accepted: 04/18/2024] [Indexed: 04/26/2024]
Abstract
Hematology is the study of diagnosis and treatment options for blood diseases, including cancer. Cancer is considered one of the deadliest diseases across all age categories. Diagnosing such a deadly disease at the initial stage is essential to cure the disease. Hematologists and pathologists rely on microscopic evaluation of blood or bone marrow smear images to diagnose blood-related ailments. The abundance of overlapping cells, cells of varying densities among platelets, non-illumination levels, and the amount of red and white blood cells make it more difficult to diagnose illness using blood cell images. Pathologists are required to put more effort into the traditional, time-consuming system. Nowadays, it becomes possible with machine learning and deep learning techniques, to automate the diagnostic processes, categorize microscopic blood cells, and improve the accuracy of the procedure and its speed as the models developed using these methods may guide an assisting tool. In this article, we have acquired, analyzed, scrutinized, and finally selected around 57 research papers from various machine learning and deep learning methodologies that have been employed in the diagnosis of leukemia and its classification over the past 20 years, which have been published between the years 2003 and 2023 by PubMed, IEEE, Science Direct, Google Scholar and other pertinent sources. Our primary emphasis is on evaluating the advantages and limitations of analogous research endeavors to provide a concise and valuable research directive that can be of significant utility to fellow researchers in the field.
Collapse
Affiliation(s)
- Hema Patel
- Smt. Chandaben Mohanbhai Patel Institute of Computer Applications, Charotar University of Science and Technology, CHARUSAT, Campus, Changa, 388421 Anand, Gujarat, India.
| | - Himal Shah
- QURE Haematology Centre, Ahmedabad 380006, Gujarat, India
| | - Gayatri Patel
- Ramanbhai Patel College of Pharmacy, Charotar University of Science and Technology, CHARUSAT, Campus, Changa, 388421 Anand, Gujarat, India
| | - Atul Patel
- Smt. Chandaben Mohanbhai Patel Institute of Computer Applications, Charotar University of Science and Technology, CHARUSAT, Campus, Changa, 388421 Anand, Gujarat, India
| |
Collapse
|
3
|
Yang F, Zhang B, Lodder P, Guo J. The burden of acute lymphoid leukemia among adolescents and young adults in the Western Pacific Region: evidence from Global Burden Disease 2019. Cancer Causes Control 2024; 35:839-848. [PMID: 38227176 DOI: 10.1007/s10552-023-01843-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 12/05/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE Acute lymphoblastic leukemia (ALL) is a type of blood cancer that affects white blood cells. Here, we use data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, to estimate the burden and incidence rate changes in adolescents and young adults (AYA) ALL in the Western Pacific Region and to reveal potential risk factors of incidence- and mortality rates. METHODS The GBD 2019 study data was stratified by sex, age, country, and territory. We calculated the Estimated annual percentage changes (estimated APC) in mortality and incidence rates for each of the 25 countries and territories of the western Pacific region from 1990 to 2019. RESULTS This study found global AYA ALL incidence rates had increased while the mortality rates had decreased between 1990 and 2019. Moreover, healthcare access and quality (HAQ), and government per capita health spending were identified as country-level risk factors of AYA ALL incidence rates, while HAQ, male education, and sex were identified as mortality rate predictors in 25 Western Pacific Region countries. CONCLUSION To address and reduce the burden of incidence and mortality among AYA, various regions around the world, particularly developing countries, could revise their AYA prevention and treatment strategies.
Collapse
Affiliation(s)
- Fan Yang
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, No.38 Xue Yuan Rd., Haidian District, Beijing, People's Republic of China, 100191
| | - Bo Zhang
- Department of Neurology and ICCTR Biostatistics and Research Design Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Paul Lodder
- Department of Methodology and Statistics, Tilburg University, Tilburg, The Netherlands
| | - Jing Guo
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, No.38 Xue Yuan Rd., Haidian District, Beijing, People's Republic of China, 100191.
| |
Collapse
|
4
|
Romero-Morelos P, González-Yebra AL, Bueno-Rosario LJ, González-Yebra B. Leukemia Types and Subtypes Analysis: Epidemiological Age-Standardized Exploration in the Mexican Bajio Region. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:731. [PMID: 38792914 PMCID: PMC11123364 DOI: 10.3390/medicina60050731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/13/2024] [Accepted: 04/16/2024] [Indexed: 05/26/2024]
Abstract
Background and Objectives: Leukemia, characterized by abnormal leukocyte production, exhibits clonal origin from somatic mutations. Globally, it ranked 15th in cancer incidence in 2020, with higher prevalence in developing countries. In Mexico, it was the ninth most frequent cancer. Regional registries are vital for understanding its epidemiology. This study aims to analyze the prevalence and age-standardized incidence rates of leukemias in a tertiary care hospital in the Mexican Bajio region. Materials and Methods: Leukemia cases from 2008-2018 were analyzed, and 535 medical records were included in this study. The prevalence, distribution, and age-specific incidence rate of different types and subtypes of leukemia were determined according to sex and age groups. Results: Overall, 65.79% consisted of lymphocytic leukemia, 33.64% of myeloid leukemia, and 0.56% of monocytic leukemia. No significant sex-based differences were found, but age-specific patterns were observed. Leukemia distribution by age revealed significant associations. Lymphocytic leukemia dominated in the pediatric population, particularly acute lymphocytic leukemia, while myeloid leukemia shifted towards adulthood. Age-specific incidence patterns showed, first, that lymphocytic leukemia is the most common leukemia in pediatric ages, and second, there is a shift from acute lymphocytic leukemia dominance in pediatric ages to myeloid leukemia incidence in late adulthood, emphasizing nuanced epidemiological dynamics. Conclusions: Acute leukemia cases occurred with high prevalence in our study population, with a high incidence in pediatric and adulthood populations, especially for acute lymphocytic leukemia, showing a (<18 years) 153.8 age-standardized incidence rate in the pediatric group, while in the adult population, the age-standardized rate was 59.84. In the age-specific analysis, we found that the childhood group (5-9 years) were the most affected by acute lymphocytic leukemia in the pediatric population, while in the adult population, the early-adulthood group (15-29 years) were the most affected age group. In contrast, chronic myeloid leukemia affected both adults and the pediatric populations, while chronic lymphocytic leukemia and monocytic leukemia were exclusive to adults. The study underscores the need for tailored diagnostic, treatment, and preventive strategies based on age, contributing valuable insights into the leukemia epidemiology of the Bajio region.
Collapse
Affiliation(s)
- Pablo Romero-Morelos
- Departamento de Investigación, Universidad Estatal del Valle de Ecatepec, Ecatepec 55210, Estado de México, Mexico
| | - Ana Lilia González-Yebra
- Departamento de Ciencias Aplicadas al Trabajo, División Ciencias de la Salud, Universidad de Guanajuato, Campus León, León 37670, Guanajuato, Mexico
| | - Luis Jonathan Bueno-Rosario
- Unidad de Investigación, Hospital Regional de Alta Especialidad del Bajío, Servicios de Salud del Instituto Mexicano del Seguro Social para el Bienestar (IMSS-BIENESTAR), León 37544, Guanajuato, Mexico
| | - Beatriz González-Yebra
- Unidad de Investigación, Hospital Regional de Alta Especialidad del Bajío, Servicios de Salud del Instituto Mexicano del Seguro Social para el Bienestar (IMSS-BIENESTAR), León 37544, Guanajuato, Mexico
- Departamento de Medicina y Nutrición, División Ciencias de la Salud, Universidad de Guanajuato, Campus León, León 37670, Guanajuato, Mexico
| |
Collapse
|
5
|
Dhir A, Rahul R, Liu Q, Pham D, Kronenfeld R, Koru‐Sengul T, Pinheiro PS. Disparities in incidence and survival for patients with Ewing sarcoma in Florida. Cancer Med 2024; 13:e7151. [PMID: 38650521 PMCID: PMC11036070 DOI: 10.1002/cam4.7151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 01/12/2024] [Accepted: 03/18/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Ewing sarcoma (ES) is a malignant bone tumor most commonly affecting non-Hispanic White (NHW) adolescent males, though recognition among Hispanic individuals is rising. Prior population-based studies in the United States (US), utilizing Surveillance, Epidemiology, and End Results (SEER) have shown higher all-cause mortality among White Hispanics, Blacks, and those of low socioeconomic status (SES). Florida is not part of SEER but is home to unique Hispanic populations including Cubans, Puerto Ricans, South Americans that contrasts with the Mexican Hispanic majority in other US states. This study aimed to assess racial/ethnic disparities on incidence and survival outcomes among this diverse Florida patient population. METHODOLOGY Our study examined all patients diagnosed with osseous ES (2005-2018) in Florida (n = 411) based on the state's population-based cancer registry dataset. Florida Age-adjusted Incidence Rates (AAIRs) were computed by sex and race-ethnicity and compared to the equivalent populations in SEER. Cause-specific survival disparities among Florida patients were examined using Kaplan-Meier analysis. Univariable and multivariable analyses using Cox regression were performed for race/ethnicity, with adjustment for age, sex, year of diagnosis, site of disease, staging, SES, and insurance type. RESULTS There was a significantly higher incidence of osseous ES in Florida Hispanic males (AAIR 2.6/1,000,000); (95% CI: 2.0-3.2 per 1,000,000; n = 84) compared to the SEER Hispanic males (AAIR 1.2/1,000,000;1.1-1.4 per 1,000,000; n = 382). Older age, distant metastasis, lack of chemotherapy or surgical resection were statistically significant determinants of poor survival while SES, insurance status and race-ethnicity were not. However, among nonmetastatic ES, Florida Hispanics had an increased risk of death compared to Florida NHW (adjusted Hazard Ratio 2.32; 95%CI: 1.20-4.46; p = 0.012). CONCLUSIONS Florida Hispanic males have a higher-than-expected incidence of osseous ES compared to the US. Hispanics of both sexes show remarkably worse survival for nonmetastatic disease compared to NHW. This disparity is likely multifactorial and requires further in-depth studies.
Collapse
Affiliation(s)
- Aditi Dhir
- University of Miami Miller School of MedicineMiamiFloridaUSA
- Division of Pediatric Hematology/Oncology, Department of PediatricsUniversity of Miami Miller School of MedicineMiamiFloridaUSA
- Sylvester Comprehensive Cancer CenterUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Rachna Rahul
- University of Miami Miller School of MedicineMiamiFloridaUSA
- Division of Epidemiology & Population Health Sciences, Department of Public Health SciencesUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Qinran Liu
- Division of Epidemiology & Population Health Sciences, Department of Public Health SciencesUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Dan Pham
- University of Miami Miller School of MedicineMiamiFloridaUSA
- Division of Pediatric Hematology/Oncology, Department of PediatricsUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Rachel Kronenfeld
- University of Miami Miller School of MedicineMiamiFloridaUSA
- Division of Pediatric Hematology/Oncology, Department of PediatricsUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Tulay Koru‐Sengul
- University of Miami Miller School of MedicineMiamiFloridaUSA
- Sylvester Comprehensive Cancer CenterUniversity of Miami Miller School of MedicineMiamiFloridaUSA
- Division of Biostatistics, Department of Public Health SciencesUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Paulo S. Pinheiro
- University of Miami Miller School of MedicineMiamiFloridaUSA
- Sylvester Comprehensive Cancer CenterUniversity of Miami Miller School of MedicineMiamiFloridaUSA
- Division of Biostatistics, Department of Public Health SciencesUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| |
Collapse
|
6
|
Romero-Morelos P, González-Yebra AL, Muñoz-López D, Lara-Lona E, González-Yebra B. Frequencies of BCR::ABL1 Transcripts in Patients with Chronic Myeloid Leukemia: A Meta-Analysis. Genes (Basel) 2024; 15:232. [PMID: 38397221 PMCID: PMC10888370 DOI: 10.3390/genes15020232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 01/30/2024] [Accepted: 02/03/2024] [Indexed: 02/25/2024] Open
Abstract
Chronic myeloid leukemia (CML) is associated with the Philadelphia chromosome and distinct BCR::ABL1 gene transcripts. We assessed the frequencies of these transcripts in Mexico, Latin America, and worldwide. We determined the prevalence of BCR::ABL1 transcripts in CML patients and intercontinental or regional variations using specialized databases and keywords. We analyzed 34 studies from 20 countries, encompassing 5795 patients. Keyword-based searches in specialized databases guided data collection. ANOVA was employed for transcript distribution analysis. The b3a2 transcript was most prevalent globally, followed by b2a2, with e1a2 being the least frequent. Interestingly, Mexico City exhibited a higher incidence of b2a2, while b3a2 predominated in the remaining country. Overall, no significant intercontinental or regional variations were observed. b3a2 was the most common BCR::ABL1 transcript worldwide, with b2a2 following closely; e1a2 was infrequent. Notably, this trend remained consistent in Mexico. Evaluating transcript frequencies holds clinical relevance for CML management. Understanding the frequency of transcript informs personalized CML treatments.
Collapse
Affiliation(s)
- Pablo Romero-Morelos
- Department of Research, State University of the Valley of Ecatepec, Ecatepec 55210, Mexico State, Mexico
| | - Ana Lilia González-Yebra
- Department of Applied Sciences to Work, Division of Health Sciences, University of Guanajuato, Campus León, León 37320, Guanajuato, Mexico;
| | - Daniela Muñoz-López
- Department of Medicine and Nutrition, Division of Health Sciences, University of Guanajuato, Campus León, León 37320, Guanajuato, Mexico; (D.M.-L.); (E.L.-L.)
| | - Elia Lara-Lona
- Department of Medicine and Nutrition, Division of Health Sciences, University of Guanajuato, Campus León, León 37320, Guanajuato, Mexico; (D.M.-L.); (E.L.-L.)
| | - Beatriz González-Yebra
- Department of Medicine and Nutrition, Division of Health Sciences, University of Guanajuato, Campus León, León 37320, Guanajuato, Mexico; (D.M.-L.); (E.L.-L.)
- Research Unit, Bajío Regional High Specialty Hospital, León, Guanajuato, Blvd. Milenio, Col, San Carlos, León 37544, Guanajuato, Mexico
| |
Collapse
|
7
|
Ekpa QL, Akahara PC, Anderson AM, Adekoya OO, Ajayi OO, Alabi PO, Okobi OE, Jaiyeola O, Ekanem MS. A Review of Acute Lymphocytic Leukemia (ALL) in the Pediatric Population: Evaluating Current Trends and Changes in Guidelines in the Past Decade. Cureus 2023; 15:e49930. [PMID: 38179374 PMCID: PMC10766210 DOI: 10.7759/cureus.49930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 01/06/2024] Open
Abstract
Acute lymphocytic leukemia (ALL) is a commonly diagnosed cancer in children. Despite technological advancements to improve treatment and survival rates, there has been a steady increase in the incidence of ALL and treatment failures. This paper discusses the pathogenic interaction between genetic and environmental factors leading to childhood ALL. It evaluates the current treatment guidelines and notable obstacles leading to resistance, relapse, and treatment toxicities. The review evaluates a 10-year trend in the management guidelines of pediatric ALL through a systematic literature review of records from 2012 to 2023. Findings show that improvement in the five-year survival rates, notwithstanding rates of relapse and incurable diseases, is still high. Furthermore, several risk factors, including an interplay between genetic and environmental factors, are largely contributory to the outcome of ALL treatments and its overall incidence. Moreover, huge financial costs have remained a significant challenge in outcomes. There remains a need to provide individualized treatment plans, shared decision-making, and goals of care as parts of the management guidelines for the best possible outcomes. We expect that future advancements will increase overall survival rates and disease-free years.
Collapse
Affiliation(s)
- Queen L Ekpa
- General Practice, Conestoga College, Kitchener, CAN
| | | | - Alexis M Anderson
- Pediatric Medicine, St. George's University, School of Medicine, St. George's, GRD
| | | | - Olamide O Ajayi
- Pediatrics, Medway Maritime Hospital, Kent, GBR
- Internal Medicine, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Sagamu, NGA
| | - Peace O Alabi
- Pediatrics, University of Abuja Teaching Hospital, Abuja, NGA
| | - Okelue E Okobi
- Family Medicine, Larkin Community Hospital Palm Springs Campus, Hialeah, USA
- Family Medicine, Medficient Health Systems, Laurel, USA
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
| | | | - Medara S Ekanem
- General Medicine, Babcock University Teaching Hospital, Ilishan-Remo, NGA
| |
Collapse
|
8
|
Kourti M, Aivaliotis M, Hatzipantelis E. Proteomics in Childhood Acute Lymphoblastic Leukemia: Challenges and Opportunities. Diagnostics (Basel) 2023; 13:2748. [PMID: 37685286 PMCID: PMC10487225 DOI: 10.3390/diagnostics13172748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/20/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
Acute lymphoblastic leukemia (ALL) is the most common cancer in children and one of the success stories in cancer therapeutics. Risk-directed therapy based on clinical, biologic and genetic features has played a significant role in this accomplishment. Despite the observed improvement in survival rates, leukemia remains one of the leading causes of cancer-related deaths. Implementation of next-generation genomic and transcriptomic sequencing tools has illustrated the genomic landscape of ALL. However, the underlying dynamic changes at protein level still remain a challenge. Proteomics is a cutting-edge technology aimed at deciphering the mechanisms, pathways, and the degree to which the proteome impacts leukemia subtypes. Advances in mass spectrometry enable high-throughput collection of global proteomic profiles, representing an opportunity to unveil new biological markers and druggable targets. The purpose of this narrative review article is to provide a comprehensive overview of studies that have utilized applications of proteomics in an attempt to gain insight into the pathogenesis and identification of biomarkers in childhood ALL.
Collapse
Affiliation(s)
- Maria Kourti
- Third Department of Pediatrics, School of Medicine, Aristotle University and Hippokration General Hospital, 54642 Thessaloniki, Greece
| | - Michalis Aivaliotis
- Laboratory of Biological Chemistry, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Emmanouel Hatzipantelis
- Children & Adolescent Hematology-Oncology Unit, Second Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| |
Collapse
|
9
|
Montes-Rodríguez IM, Soto-Salgado M, Torres-Cintrón CR, Tomassini-Fernandini JC, Suárez E, Clavell LA, Cadilla CL. Incidence and Mortality Rates for Childhood Acute Lymphoblastic Leukemia in Puerto Rican Hispanics, 2012-2016. Cancer Epidemiol Biomarkers Prev 2023; 32:1030-1037. [PMID: 37222662 PMCID: PMC10524932 DOI: 10.1158/1055-9965.epi-22-1227] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/24/2023] [Accepted: 05/01/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Acute lymphoblastic leukemia (ALL) accounts for 80% of all leukemias diagnosed in children. Although ALL age patterns are consistent across racial/ethnic groups, their incidence and mortality rates are highly variable. We assessed the age-standardized ALL incidence and mortality rates of Puerto Rican Hispanic (PRH) children and compared them with those of US mainland Hispanics (USH), non-Hispanic Whites (NHW), non-Hispanic Blacks (NHB), and Non-Hispanic Asian or Pacific Islanders (NHAPI). METHODS Differences between racial/ethnic groups were assessed by estimating the standardized rate ratio (SRR) for 2010 to 2014. Secondary data analyses of the Puerto Rico Central Cancer Registry and the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) databases were performed for the 2001 to 2016 period. RESULTS PRH children had 31% lower incidence rates than USH, but 86% higher incidence rates than NHB. In addition, the incidence trends of ALL increased significantly from 2001 to 2016 among PRH and USH, with 5% and 0.9% per year, respectively. Moreover, PRH have a lower 5-year overall survival (81.7%) when compared with other racial/ethnic groups. CONCLUSIONS PRH children were found to have disparities in ALL incidence and mortality rates compared with other racial/ethnic groups in the US. Additional research is warranted to identify the genetic and environmental risk factors that may be associated with the disparities observed. IMPACT This is the first study reporting the incidence and mortality rates of childhood ALL for PRH and making comparisons with other racial/ethnic groups in the US. See related commentary by Mejía-Aranguré and Núñez-Enríquez, p. 999.
Collapse
Affiliation(s)
| | - Marievelisse Soto-Salgado
- Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, PR
| | - Carlos R. Torres-Cintrón
- Puerto Rico Central Cancer Registry, University of Puerto Rico Comprehensive Cancer Center, San Juan, PR
| | | | - Erick Suárez
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, PR
| | - Luis A. Clavell
- Division of Pediatric Oncology, San Jorge Children’s Hospital, San Juan, PR
| | - Carmen L. Cadilla
- Department of Biochemistry, School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, PR
| |
Collapse
|
10
|
Pottosin I, Olivas-Aguirre M, Dobrovinskaya O. In vitro simulation of the acute lymphoblastic leukemia niche: a critical view on the optimal approximation for drug testing. J Leukoc Biol 2023; 114:21-41. [PMID: 37039524 DOI: 10.1093/jleuko/qiad039] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/12/2023] Open
Abstract
Acute lymphoblastic leukemia with the worst prognosis is related to minimal residual disease. Minimal residual disease not only depends on the individual peculiarities of leukemic clones but also reflects the protective role of the acute lymphoblastic leukemia microenvironment. In this review, we discuss in detail cell-to-cell interactions in the 2 leukemic niches, more explored bone marrow and less studied extramedullary adipose tissue. A special emphasis is given to multiple ways of interactions of acute lymphoblastic leukemia cells with the bone marrow or extramedullary adipose tissue microenvironment, indicating observed differences in B- and T-cell-derived acute lymphoblastic leukemia behavior. This analysis argued for the usage of coculture systems for drug testing. Starting with a review of available sources and characteristics of acute lymphoblastic leukemia cells, mesenchymal stromal cells, endothelial cells, and adipocytes, we have then made an update of the available 2-dimensional and 3-dimensional systems, which bring together cellular elements, components of the extracellular matrix, or its imitation. We discussed the most complex available 3-dimensional systems like "leukemia-on-a-chip," which include either a prefabricated microfluidics platform or, alternatively, the microarchitecture, designed by using the 3-dimensional bioprinting technologies. From our analysis, it follows that for preclinical antileukemic drug testing, in most cases, intermediately complex in vitro cell systems are optimal, such as a "2.5-dimensional" coculture of acute lymphoblastic leukemia cells with niche cells (mesenchymal stromal cells, endothelial cells) plus matrix components or scaffold-free mesenchymal stromal cell organoids, populated by acute lymphoblastic leukemia cells. Due to emerging evidence for the correlation of obesity and poor prognosis, a coculture of adipocytes with acute lymphoblastic leukemia cells as a drug testing system is gaining shape.
Collapse
Affiliation(s)
- Igor Pottosin
- Laboratory of Immunobiology and Ionic Transport Regulation, University Center for Biomedical Research, University of Colima, Av. Enrique Arreola Silva 883, Guzmán City, Jalisco, 49000, Mexico
| | - Miguel Olivas-Aguirre
- Laboratory of Immunobiology and Ionic Transport Regulation, University Center for Biomedical Research, University of Colima, Av. Enrique Arreola Silva 883, Guzmán City, Jalisco, 49000, Mexico
- Division of Exact, Natural and Technological Sciences, South University Center (CUSUR), University of Guadalajara, Jalisco, Mexico
| | - Oxana Dobrovinskaya
- Laboratory of Immunobiology and Ionic Transport Regulation, University Center for Biomedical Research, University of Colima, Av. Enrique Arreola Silva 883, Guzmán City, Jalisco, 49000, Mexico
| |
Collapse
|
11
|
Aureli A, Marziani B, Venditti A, Sconocchia T, Sconocchia G. Acute Lymphoblastic Leukemia Immunotherapy Treatment: Now, Next, and Beyond. Cancers (Basel) 2023; 15:3346. [PMID: 37444456 DOI: 10.3390/cancers15133346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/14/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
Acute lymphoblastic leukemia (ALL) is a blood cancer that primarily affects children but also adults. It is due to the malignant proliferation of lymphoid precursor cells that invade the bone marrow and can spread to extramedullary sites. ALL is divided into B cell (85%) and T cell lineages (10 to 15%); rare cases are associated with the natural killer (NK) cell lineage (<1%). To date, the survival rate in children with ALL is excellent while in adults continues to be poor. Despite the therapeutic progress, there are subsets of patients that still have high relapse rates after chemotherapy or hematopoietic stem cell transplantation (HSCT) and an unsatisfactory cure rate. Hence, the identification of more effective and safer therapy choices represents a primary issue. In this review, we will discuss novel therapeutic options including bispecific antibodies, antibody-drug conjugates, chimeric antigen receptor (CAR)-based therapies, and other promising treatments for both pediatric and adult patients.
Collapse
Affiliation(s)
- Anna Aureli
- CNR Institute of Translational Pharmacology, Via Carducci 32, 67100 L'Aquila, Italy
| | - Beatrice Marziani
- Emergency Medicine Department, Sant'Anna University Hospital, Via A. Moro, 8, Cona, 44124 Ferrara, Italy
| | - Adriano Venditti
- Department of Biomedicine and Prevention, The University of Rome "Tor Vergata", 00133 Rome, Italy
| | - Tommaso Sconocchia
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Giuseppe Sconocchia
- CNR Institute of Translational Pharmacology, Via Carducci 32, 67100 L'Aquila, Italy
| |
Collapse
|
12
|
Harris RD, Bernhardt MB, Zobeck M, Taylor O, Gramatges MM, Schafer ES, Lupo PJ, Rabin KR, Scheurer ME, Brown AL. Ethnic-specific predictors of neurotoxicity among patients with pediatric acute lymphoblastic leukemia after high-dose methotrexate. Cancer 2023; 129:1287-1294. [PMID: 36692972 PMCID: PMC10625847 DOI: 10.1002/cncr.34646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 12/02/2022] [Accepted: 12/10/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND High-dose methotrexate (HD-MTX; 5000 mg/m2 ) is an important component of curative therapy in many treatment regimens for high-risk pediatric acute lymphoblastic leukemia (ALL). However, methotrexate therapy can result in dose-limiting neurotoxicity, which may disproportionately affect Latino children. This study evaluated risk factors for neurotoxicity after HD-MTX in an ethnically diverse population of patients with ALL. METHODS The authors retrospectively reviewed the medical records of patients who were diagnosed with ALL and treated with HD-MTX at Texas Children's Cancer Center (2010-2017). Methotrexate neurotoxicity was defined as a neurologic episode (e.g., seizures or stroke-like symptoms) occurring within 21 days of HD-MTX that resulted in methotrexate treatment modifications. Mixed effects multivariable logistic regression was used to estimate the odds ratio (OR) and corresponding 95% confidence interval (CI) for the association between clinical factors and neurotoxicity. RESULTS Overall, 351 patients (58.1% Latino) who received 1183 HD-MTX infusions were evaluated. Thirty-five patients (10%) experienced neurotoxicity, 71% of whom were Latino. After adjusting for clinical risk factors, the authors observed that serum creatinine elevations ≥50% of baseline were associated with a three-fold increased odds (OR, 3.32; 95% CI, 0.98-11.21; p = .05) for neurotoxicity compared with creatinine elevation <25%. Notably, predictors of neurotoxicity differed by ethnicity. Specifically, Latino children experienced a nearly six-fold increase in neurotoxicity odds (OR, 5.80; 95% CI, 1.39-24.17; p = .02) with serum creatinine elevation ≥50% compared with creatinine elevation <25%. CONCLUSIONS The current findings indicate that serum creatinine elevations ≥50% may be associated with an increased risk for neurotoxicity among Latino children with ALL and may identify potential candidates for therapeutic or supportive care interventions.
Collapse
Affiliation(s)
- Rachel D. Harris
- Department of Pediatrics, Section of Hematology/Oncology, Baylor College of Medicine, Houston, Texas
- Texas Children’s Hospital, Texas Children’s Cancer and Hematology Centers, Houston, Texas
| | - M. Brooke Bernhardt
- Department of Pediatrics, Section of Hematology/Oncology, Baylor College of Medicine, Houston, Texas
- Texas Children’s Hospital, Texas Children’s Cancer and Hematology Centers, Houston, Texas
| | - Mark Zobeck
- Department of Pediatrics, Section of Hematology/Oncology, Baylor College of Medicine, Houston, Texas
- Texas Children’s Hospital, Texas Children’s Cancer and Hematology Centers, Houston, Texas
| | - Olga Taylor
- Department of Pediatrics, Section of Hematology/Oncology, Baylor College of Medicine, Houston, Texas
- Texas Children’s Hospital, Texas Children’s Cancer and Hematology Centers, Houston, Texas
| | - M. Monica Gramatges
- Department of Pediatrics, Section of Hematology/Oncology, Baylor College of Medicine, Houston, Texas
- Texas Children’s Hospital, Texas Children’s Cancer and Hematology Centers, Houston, Texas
| | - Eric S. Schafer
- Department of Pediatrics, Section of Hematology/Oncology, Baylor College of Medicine, Houston, Texas
- Texas Children’s Hospital, Texas Children’s Cancer and Hematology Centers, Houston, Texas
| | - Philip J. Lupo
- Department of Pediatrics, Section of Hematology/Oncology, Baylor College of Medicine, Houston, Texas
- Texas Children’s Hospital, Texas Children’s Cancer and Hematology Centers, Houston, Texas
| | - Karen R. Rabin
- Department of Pediatrics, Section of Hematology/Oncology, Baylor College of Medicine, Houston, Texas
- Texas Children’s Hospital, Texas Children’s Cancer and Hematology Centers, Houston, Texas
| | - Michael E. Scheurer
- Department of Pediatrics, Section of Hematology/Oncology, Baylor College of Medicine, Houston, Texas
- Texas Children’s Hospital, Texas Children’s Cancer and Hematology Centers, Houston, Texas
| | - Austin L. Brown
- Department of Pediatrics, Section of Hematology/Oncology, Baylor College of Medicine, Houston, Texas
- Texas Children’s Hospital, Texas Children’s Cancer and Hematology Centers, Houston, Texas
| |
Collapse
|
13
|
Munir F, He J, Connors J, Garcia M, Gibson A, McCall D, Nunez C, Dinh CN, Robusto L, Roth M, Khazal S, Tewari P, Cuglievan B. Translational advances in the treatment of childhood acute lymphoblastic leukemia: narrative review of current and emerging molecular and immunotherapies. Transl Pediatr 2023; 12:487-502. [PMID: 37035397 PMCID: PMC10080491 DOI: 10.21037/tp-22-656] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/08/2023] [Indexed: 03/01/2023] Open
Abstract
Background and Objective Acute lymphoblastic leukemia (ALL) is the most common hematologic malignancy of lymphoid origin in children. The prognosis for newly diagnosed ALL in the pediatric population is generally favorable, with a 5-year overall survival rate of more than 90%. Though conventional therapy has led to meaningful improvements in cure rates for new-onset pediatric ALL, one-third of patients still experience a relapse or refractory disease, contributing to a significant cause of pediatric cancer-related mortality. Methods An extensive literature review was undertaken via various databases of medical literature, focusing on both results of larger clinical trials, but also with evaluation of recent abstract publications at large hematologic conferences. Key Content and Findings Remission is achievable in most of these patients by re-induction with currently available therapies, but the long-term overall survival rate is deemed suboptimal and remains a therapeutic challenge. As part of never-ceasing efforts to improve pediatric ALL outcomes, newer modalities, including targeted molecular therapies as well as immunotherapy, and chimeric antigen receptor (CAR) T-cell therapy, are currently being employed to increase treatment effectiveness as well as lessen the side effects from conventional chemotherapy. These approaches explore the use of early genome-based disease characterization and medications developed against actionable molecular targets. Conclusions Additional clinical research is nonetheless required to learn more about the potentially harmful effects of targeted therapies and investigate the possibility of these agents replacing or decreasing the use of conventional chemotherapy in treating pediatric ALL.
Collapse
Affiliation(s)
- Faryal Munir
- Department of Pediatrics, Pediatric Hematology Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jiasen He
- Department of Pediatrics, Pediatric Hematology Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeremy Connors
- Department of Pediatrics, Pediatric Hematology Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Miriam Garcia
- Department of Pediatrics, Pediatric Hematology Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amber Gibson
- Department of Pediatrics, Pediatric Hematology Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David McCall
- Department of Pediatrics, Pediatric Hematology Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Cesar Nunez
- Department of Pediatrics, Pediatric Hematology Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christine Nguyen Dinh
- Department of Pediatrics, Pediatric Hematology Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lindsay Robusto
- Department of Pediatrics, Pediatric Hematology Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael Roth
- Department of Pediatrics, Pediatric Hematology Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sajad Khazal
- Department of Pediatrics, Pediatric Hematology Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Priti Tewari
- Department of Pediatrics, Pediatric Hematology Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Branko Cuglievan
- Department of Pediatrics, Pediatric Hematology Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
14
|
Wang X, Brown DS, Cao Y, Ekenga CC, Guo S, Johnson KJ. Health Insurance Coverage and Racial/Ethnic Disparities in U.S. Childhood and Adolescent Cancer Survival. J Pediatr 2023:113378. [PMID: 36889628 DOI: 10.1016/j.jpeds.2023.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/06/2023] [Accepted: 02/20/2023] [Indexed: 03/10/2023]
Abstract
OBJECTIVE To evaluate potential effect modification by health insurance coverage on racial and ethnic disparities in cancer survival among U.S. children and adolescents. STUDY DESIGN Data from 54,558 individuals diagnosed with cancer at ≤ 19 years between 2004 and 2010 were obtained from the National Cancer Database. Cox proportional hazards regression was used for analyses. An interaction term between race/ethnicity and health insurance type was included to examine racial/ethnic disparities in survival by each insurance status category. RESULTS Racial/ethnic minorities experienced a 14-42% higher hazard of death compared with non-Hispanic Whites with magnitudes varying by health insurance type (Pinteraction < 0.001). Specifically, among those reported as privately insured, the hazard of death was higher for non-Hispanic Blacks (hazard ratio [HR]=1.48, 95% confidence interval [CI]: 1.36-1.62), non-Hispanic American Indian/Alaskan Natives (HR=1.30, 95%CI: 1.13-1.50), non-Hispanic Asians or Pacific Islanders (HR=1.99, 95%CI: 1.36-2.90) and Hispanics (HR=1.28, 95%CI: 1.17-1.40) vs. non-Hispanic Whites. Racial/ethnic disparities in survival among those reported as covered by Medicaid were present for non-Hispanic Blacks (HR=1.30, 95%CI: 1.19-1.43) but no other racial/ethnic minorities (HR ranges: 0.98∼1.00) vs. non-Hispanic Whites. In the uninsured group, the hazard of death for non-Hispanic Blacks (HR=1.68, 95%CI: 1.26-2.23) and Hispanics (HR=1.27, 95%CI: 1.01-1.61) was higher vs. non-Hispanic Whites. CONCLUSIONS Disparities in survival exist across insurance types, particularly for non-Hispanic Black childhood and adolescent cancer patients vs. non-Hispanic Whites with private insurance. These findings provide insights for research and policy and point to the need for more efforts on promoting health equity while improving health insurance coverage.
Collapse
Affiliation(s)
- Xiaoyan Wang
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Derek S Brown
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Yin Cao
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA; Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Shenyang Guo
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Kimberly J Johnson
- Brown School, Washington University in St. Louis, St. Louis, MO, USA; Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.
| |
Collapse
|
15
|
Yang Y, Yu C, Fu R, Xia S, Ni H, He Y, Zhu K, Sun Q. Association of cesarean section with risk of childhood leukemia: A meta-analysis from an observational study. Hematol Oncol 2023; 41:182-191. [PMID: 36000274 DOI: 10.1002/hon.3070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 08/15/2022] [Accepted: 08/20/2022] [Indexed: 02/03/2023]
Abstract
Recent studies suggest that children born via cesarean section (CS) are predisposed to immune-mediated diseases later in life. The association between CS and childhood leukemia was investigated in this meta-analysis of observational studies. Two researchers independently searched PubMed, Web of Science, Embase, and Cochrane Library for literature on the association between CS and childhood leukemia before February 2022. And pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated to determine the link between CS and childhood leukemia. The preliminary search resulted in 1321 articles and 16 articles were finally included after screening. The primary outcome was the risk of leukemia in children born via CS versus those born vaginally. The results revealed that having a CS was associated with an increased risk of childhood leukemia compared to having vaginal section (VS) (OR = 1.07, 95% CI: 1.02-1.13, p = 0.01), especially for acute lymphoblastic leukemia (ALL) (OR = 1.09, 95% CI: 1.03-1.16, p = 0.004). Children delivered via elective CS had a higher risk of ALL (OR = 1.18, 95% CI: 1.07-1.31, p = 0.001), but emergency CS did not. It is worth noting that neither emergency CS nor elective CS were found to be associated with acute myeloid leukemia. Compared to VS, CS increased the risk of leukemia in children, with elective CS significantly increasing ALL risk.
Collapse
Affiliation(s)
- Yingzhu Yang
- Department of Gynecology, Ningbo Women and Children's Hospital, Ningbo, Zhejiang, China
| | - Chiyuan Yu
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Rongrong Fu
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Shishan Xia
- Department of Medicine, Ningbo Women and Children's Hospital, Ningbo, Zhejiang, China
| | - Haixiang Ni
- Department of Endocrinology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Yujing He
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Keying Zhu
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Qian Sun
- Department of Obstetrics and Gynecology, Ningbo Yinzhou No. 2 Hospital, Ningbo, Zhejiang, China
| |
Collapse
|
16
|
Prescott S, Schminkey D, Abukhalaf D, DeGuzman P, Dreisbach C. A framework to guide research and practice response to emerging infectious diseases: Genomic-to-global considerations. Public Health Nurs 2023; 40:144-152. [PMID: 36128924 DOI: 10.1111/phn.13133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/10/2022] [Accepted: 09/01/2022] [Indexed: 01/14/2023]
Abstract
Newly emerging infectious diseases (EIDs), like the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, are becoming increasingly common. Due to geographic, political, social, behavioral, and genomic differences, some populations are more vulnerable to infectious disease spread than others. The purpose of this article is to present a framework for research and practice response to emergent infectious diseases that addresses multiple transdisciplinary actions to limit exposure or mitigate adverse outcomes for individuals and communities. Recent experience with new strains of emergent infectious diseases reinforces the importance of intervening at multiple levels, from genomics to political messaging to create multipronged, transdisciplinary interventions to contain the threat. In particular, incorporation of genomics into public health nursing practice of infectious diseases management can enhance existing regional-, community-, and individual-level health promotion and protection efforts, thus impacting long-term health outcomes.
Collapse
Affiliation(s)
| | - Donna Schminkey
- College of Health and Behavioral Studies, James Madison University, Harrisonburg, Virginia
| | | | - Pamela DeGuzman
- School of Nursing, University of Virginia, Charlottesville, Virginia
| | | |
Collapse
|
17
|
Alqahtani A, Alhousari D, Ali A, Yaghmour G, Orgel E, Curran E, Stock W, Bhojwani D, Alachkar H. Asparaginase toxicity in Hispanic adult and pediatric patients with acute lymphoblastic leukemia: current understanding. Expert Opin Drug Metab Toxicol 2023; 19:357-366. [PMID: 37410014 DOI: 10.1080/17425255.2023.2233412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 07/03/2023] [Indexed: 07/07/2023]
Abstract
INTRODUCTION Asparaginase is essential to chemotherapy regimens for acute lymphoblastic leukemia (ALL). Survival of patients with ALL has improved since incorporating asparaginase into chemotherapy backbones. Hispanic patients have a higher incidence of ALL than other ethnicities and suffer inferior outcomes. The inferior outcome of Hispanics is due to several factors, including the increased incidence of high-risk genetic subtypes and susceptibility to treatment-related toxicity. AREAS COVERED We summarize the current knowledge of asparaginase-related toxicity by comparing their incidence between Hispanic and non-Hispanic patients. These toxicities include hypersensitivity, hepatotoxicity, pancreatitis, thrombosis, and hypertriglyceridemia. The PubMed database and Google Scholar were used to search for this review from October 2022 to June 2023. EXPERT OPINION Except for hepatotoxicity and hypertriglyceridemia secondary to asparaginase-based treatments, which may develop more frequently among Hispanic patients with ALL, other toxicities were comparable between Hispanic and non-Hispanic patients. Nevertheless, studies with larger cohorts and more accurate capturing of Hispanic ethnicity should be conducted to fill the gaps in the current knowledge.
Collapse
Affiliation(s)
- Amani Alqahtani
- School of Pharmacy, University of Southern California, Los Angeles, CA, USA
- Department of Clinical Pharmacy, School of Pharmacy, Najran University, Najran, Saudi Arabia
| | - Diala Alhousari
- School of Pharmacy, University of Southern California, Los Angeles, CA, USA
| | - Amir Ali
- USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, USA
| | - George Yaghmour
- USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, USA
| | - Etan Orgel
- USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, USA
- Cancer and Blood Disease Institute, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Emily Curran
- The Department of Medicine, Section of Hematology & Oncology at the University of Cincinnati College of Medicine
| | - Wendy Stock
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Deepa Bhojwani
- USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, USA
- Cancer and Blood Disease Institute, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Houda Alachkar
- School of Pharmacy, University of Southern California, Los Angeles, CA, USA
- USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, USA
| |
Collapse
|
18
|
Yoo JW, Ahn A, Lee JM, Jo S, Kim S, Lee JW, Cho B, Kim Y, Kim M, Chung NG. Spectrum of Genetic Mutations in Korean Pediatric Acute Lymphoblastic Leukemia. J Clin Med 2022; 11:jcm11216298. [PMID: 36362526 PMCID: PMC9658397 DOI: 10.3390/jcm11216298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022] Open
Abstract
The wide application of next-generation sequencing (NGS) technologies has led to the discovery of multiple genetic alterations in pediatric acute lymphoblastic leukemia (ALL). In this work, we aimed to investigate the mutational spectrum in pediatric ALL. We employed a St. Mary’s customized NGS panel comprising 67 leukemia-related genes. Samples were collected from 139 pediatric ALL patients. Eighty-five patients (61.2%) harbored at least one mutation. In B-cell ALL, the RAS pathway is the most involved pathway, and the three most frequently mutated genes were NRAS (22.4%), KRAS (19.6%), and PTPN11 (8.4%). NRAS and PTPN11 were significantly associated with a high hyperdiploidy karyotype (p = 0.018 and p < 0.001, respectively). In T-cell ALL, the three most frequently mutated genes were NOTCH1 (37.5%), FBXW7 (16.6%), and PTEN (6.2%). Several pairs of co-occurring mutations were found: NRAS with SETD, NRAS with PTPN11 in B-cell ALL (p = 0.024 and p = 0.020, respectively), and NOTCH1 with FBXW7 in T-cell ALL (p < 0.001). The most frequent newly emerged mutation in relapsed ALL was NT5C2. We procured comprehensive genetic information regarding Korean pediatric ALL using NGS technology. Our findings strengthen the current knowledge of recurrent somatic mutations in pediatric ALL.
Collapse
Affiliation(s)
- Jae Won Yoo
- Department of Pediatrics, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Ari Ahn
- Catholic Genetic Laboratory Center, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Jong-Mi Lee
- Catholic Genetic Laboratory Center, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Suejung Jo
- Department of Pediatrics, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Seongkoo Kim
- Department of Pediatrics, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Jae Wook Lee
- Department of Pediatrics, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Bin Cho
- Department of Pediatrics, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Yonggoo Kim
- Catholic Genetic Laboratory Center, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Myungshin Kim
- Catholic Genetic Laboratory Center, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
- Correspondence: (M.K.); (N.-G.C.); Tel.: +82-2-2258-1645 (M.K.); +82-2-2258-6188 (N.-G.C.)
| | - Nack-Gyun Chung
- Department of Pediatrics, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
- Correspondence: (M.K.); (N.-G.C.); Tel.: +82-2-2258-1645 (M.K.); +82-2-2258-6188 (N.-G.C.)
| |
Collapse
|
19
|
Whitaker AM, Kayser K. Neuropsychological surveillance model for survivors of pediatric cancer: A descriptive report of methodology and feasibility. Clin Neuropsychol 2022; 36:1746-1766. [PMID: 33941039 DOI: 10.1080/13854046.2021.1912831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objective: Neuropsychological late effects of pediatric cancer may not become apparent for years after therapy; therefore, serial monitoring is necessary for detecting changes to ensure timely intervention. Unfortunately, lack of access to neuropsychologists, increased patient volume, insurance authorization and reimbursement issues, time required for neuropsychological evaluation, and practice effects related to repeat testing present many challenges to provision of neuropsychological care for survivors of childhood cancer. Models involving surveillance and monitoring have been proposed, though minimal data exist related to the implementation and feasibility of such models. Method: In this descriptive feasibility study, the Neuropsychology Consult Clinic (NCC) at Children's Hospital Los Angeles is presented, outlining a methodology and algorithm for neuropsychological surveillance of survivors of non-CNS pediatric cancer and an account of the first three years of clinic implementation. Participants included 215 survivors (x̅ age = 5.6 years), including 75.3% Latinx patients. Results: The overall clinic implementation was found to be feasible, with approximately 75% of patients "passing" the screening and 25% "failing" the screening. Clinical judgment only conflicted with the algorithm 8.6% of the time. However, several limitations to feasibility were noted, including validity concerns and ability/time to complete parent-reported outcomes using Spanish forms, as well as access to bilingual examiners. Conclusions: These preliminary data support the feasibility of the NCC model with limitations as outlined above. This is the first phase in a multiphase plan to develop an appropriate screening clinic for survivors of pediatric cancer, with the next phase focusing on sensitivity/specificity of measures.
Collapse
Affiliation(s)
- Ashley M Whitaker
- Cancer and Blood Disease Institute, Division of Hematology, Oncology, and Blood and Marrow Transplantation, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Kimberly Kayser
- Cancer and Blood Disease Institute, Division of Hematology, Oncology, and Blood and Marrow Transplantation, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
20
|
Huang J, Chan SC, Ngai CH, Lok V, Zhang L, Lucero-Prisno DE, Xu W, Zheng ZJ, Elcarte E, Withers M, Wong MCS. Disease Burden, Risk Factors, and Trends of Leukaemia: A Global Analysis. Front Oncol 2022; 12:904292. [PMID: 35936709 PMCID: PMC9355717 DOI: 10.3389/fonc.2022.904292] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 06/07/2022] [Indexed: 11/13/2022] Open
Abstract
Leukaemia accounted for approximately 2.5% of all new cancer incidence and 3.1% of cancer-related mortality. The investigation of its risk factors and epidemiologic trends could help describe the geographical distribution and identify high-risk population groups. This study aimed to evaluate the global incidence, mortality, associated risk factors, and temporal trends of leukaemia by sex, age, and country. We extracted incidence and mortality of leukaemia from GLOBOCAN, CI5, WHO mortality database, NORDCAN, and SEER. We searched the WHO Global Health Observatory data repository for the age-standardised prevalence of lifestyle and metabolic risk factors. We tested the trends by calculating Average Annual Percentage Change (AAPC) from Joinpoint regression. The age-standardized rate of incidence and mortality were 5.4 and 3.3 per 100,000 globally. The incidence and mortality of leukaemia were associated with Human Development Index, Gross Domestics Products per capita, prevalence of smoking, physical activity, overweight, obesity, and hypercholesterolaemia at the country level. Overall, more countries were showing decreasing trends than increasing trends in incidence and mortality. However, an increasing trend of leukaemia incidence was found in Germany, Korea, Japan, Canada and the United Kingdom (AAPC, 2.32-0.98) while its mortality increased in the Philippines, Ecuador, Belarus, and Thailand (AAPC, 2.49-1.23). There was a decreasing trend of leukaemia for the past decade while an increase in incidence and mortality was observed in some populations. More intensive lifestyle modifications should be implemented to control the increasing trends of leukaemia in regions with these trends. Future studies may explore the reasons behind these epidemiological transitions.
Collapse
Affiliation(s)
- Junjie Huang
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Sze Chai Chan
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Chun Ho Ngai
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Veeleah Lok
- Department of Global Public Health, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Lin Zhang
- School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
- School of Public Health, The Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Don Eliseo Lucero-Prisno
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Wanghong Xu
- School of Public Health, Fudan University, Shanghai, China
| | - Zhi-Jie Zheng
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | - Edmar Elcarte
- College of Nursing, University of the Philippines, Manila, Philippines
| | - Mellissa Withers
- Department of Preventive Medicine, Institute for Global Health, University of Southern California, Los Angeles, CA, United States
- *Correspondence: Mellissa Withers, ; Martin C. S. Wong,
| | - Martin C. S. Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- School of Public Health, The Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Global Health, School of Public Health, Peking University, Beijing, China
- *Correspondence: Mellissa Withers, ; Martin C. S. Wong,
| |
Collapse
|
21
|
Beauchemin M, Santacroce SJ, Bona K, Dang H, Alexander S, Allen K, De Los Santos C, Fisher B, Muñeton-Castaño Y, Ponce O, Vargas S, Sugalski A, Sung L, Parsons S. Rationale and design of Children's Oncology Group (COG) study ACCL20N1CD: financial distress during treatment of acute lymphoblastic leukemia in the United States. BMC Health Serv Res 2022; 22:832. [PMID: 35764995 PMCID: PMC9237978 DOI: 10.1186/s12913-022-08201-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/15/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The study purpose is to describe trajectories of financial distress for parents of children (ages 1-14.9 years) with newly diagnosed acute lymphoblastic leukemia (ALL). The secondary aim is to identify multilevel factors (child, parent, household, treating institution) that influence change in financial distress over time. METHODS The study uses a prospective cohort design, repeated measurements, and mixed methods. The settings are Children's Oncology Group (COG) institutions participating in the National Cancer Institute Community Oncology Research Program (NCORP). Eligible participants are English- and/or Spanish-speaking parents or legal guardians (hereafter "parents") of index children. Parents are asked to complete a survey during their child's induction (T1) and maintenance therapy (T2), and near treatment completion (T3). Study surveys include items about (a) the child's cancer and clinical course, (b) parental socio-economic status, financial distress and financial coping behaviors, and (c) household material hardships. At least 15 parents will be invited to participate in an optional semi-structured interview. NCORP institutions that enroll at least one parent must complete an annual survey about institution resources that could influence parental financial distress. DISCUSSION The results will inform future interventions to mitigate financial distress for parents of children diagnosed with ALL and could be instructive beyond this disease group. TRIAL REGISTRATION This trial was initially registered with the NCI Clinical Trial Reporting Program ID: NCI-2021-03,567 on June 16, 2021. The study can be found on clinicaltrials.gov, Identifier NCT04928599 .
Collapse
Affiliation(s)
- Melissa Beauchemin
- grid.21729.3f0000000419368729Columbia University School of Nursing, New York, NY USA ,grid.21729.3f0000000419368729Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY USA
| | - Sheila Judge Santacroce
- grid.10698.360000000122483208School of Nursing, University of North Carolina Chapel Hill, Chapel Hill, NC USA ,grid.410711.20000 0001 1034 1720Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC USA
| | - Kira Bona
- grid.2515.30000 0004 0378 8438Department of Pediatric Oncology, Division of Hematology/Oncology, Boston Children’s Hospital, Harvard Medical School, Dana-Farber Cancer Institute, Boston, MB USA
| | - Ha Dang
- grid.42505.360000 0001 2156 6853Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, CA USA
| | | | - Kamala Allen
- grid.42505.360000 0001 2156 6853Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, CA USA
| | - Crystal De Los Santos
- grid.414149.d0000 0004 0383 4967Driscoll Children’s Hospital, Corpus Christi, TX USA
| | - Beth Fisher
- grid.428158.20000 0004 0371 6071Children’s Healthcare of Atlanta, Atlanta, GA USA
| | | | - Olivia Ponce
- grid.428204.80000 0000 8741 3510Children’s Oncology Group, Monrovia, CA USA
| | - Sarah Vargas
- grid.428204.80000 0000 8741 3510Children’s Oncology Group, Monrovia, CA USA
| | - Aaron Sugalski
- grid.267309.90000 0001 0629 5880University of Texas Health Science Center at San Antonio, San Antonio, TX USA
| | | | - Susan Parsons
- grid.67033.310000 0000 8934 4045Tufts Medical Center, Institute for Clinical Research and Health Policy Studies, Boston, MA USA
| |
Collapse
|
22
|
Waters AR, Zamora ER, Fluchel M, Warner EL, Rosen S, Gwilliam V, Tovar GE, Morales JP, Kirchhoff AC. A qualitative inquiry of communication based barriers to the diagnosis of pediatric cancer: Perceptions of primarily Spanish-speaking caregivers. PATIENT EDUCATION AND COUNSELING 2022; 105:1503-1509. [PMID: 34598802 DOI: 10.1016/j.pec.2021.09.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 09/19/2021] [Accepted: 09/20/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Primarily Spanish-speaking cancer patients and caregivers often experience non-congruence with healthcare providers about beliefs, values, and knowledge of cancer. Our goal was to describe how communication related to the diagnosis of cancer was influenced by culture and language among primarily Spanish-speaking caregivers of pediatric cancer patients. METHODS Caregivers participated in three focus groups about their experiences with their child's diagnosis, communication issues, and understanding of their child's diagnosis and treatment plan. Focus groups were audio recorded, transcribed, and qualitatively analyzed using interpretive description. RESULTS Three themes emerged: 1) Negative experiences and barriers during the cancer diagnosis and treatment, 2) Miscommunication and system complexity, and 3) Language barriers throughout the diagnostic process. Due to barriers and negative experiences, some caregivers reported that their child's diagnosis was delayed, that providers sometimes used dehumanizing language, and that they were confused about diagnostic testing and treatment. CONCLUSION Cultural and linguistic disparities in pediatric oncology must be systematically addressed at the provider, clinic, and system level. PRACTICE IMPLICATIONS High-quality cancer care delivered by oncologists and cancer care teams should include cultural humility when discussing the cancer diagnosis and prognosis.
Collapse
Affiliation(s)
- Austin R Waters
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, Salt Lake City, Utah, USA.
| | - Eduardo R Zamora
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, Salt Lake City, Utah, USA; Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Mark Fluchel
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Echo L Warner
- University of Arizona Cancer Center, Tucson, Arizona, USA; College of Nursing, University of Arizona, Tucson, Arizona, USA
| | - Stephanie Rosen
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Vannina Gwilliam
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Guadalupe E Tovar
- Patient and Public Education Department, Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Jennyffer P Morales
- Center for Health Outcomes and Population Equity, Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Anne C Kirchhoff
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, Salt Lake City, Utah, USA; Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| |
Collapse
|
23
|
Fejerman L, Ramirez AG, Nápoles AM, Gomez SL, Stern MC. Cancer Epidemiology in Hispanic Populations: What Have We Learned and Where Do We Need to Make Progress? Cancer Epidemiol Biomarkers Prev 2022; 31:932-941. [PMID: 35247883 DOI: 10.1158/1055-9965.epi-21-1303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/09/2022] [Accepted: 03/01/2022] [Indexed: 11/16/2022] Open
Abstract
The Hispanic/Latino(x) population (H/L) in the United States of America is heterogeneous and fast growing. Cancer is the number one cause of death among H/Ls, accounting for 21% of deaths. Whereas for the most common cancers, incidence rates are lower in H/Ls compared with non-H/L White (NHW) individuals, H/Ls have a higher incidence of liver, stomach, cervical, penile, and gallbladder cancers. H/L patients tend to be diagnosed at more advanced stages for breast, colorectal, prostate, and lung cancers, and melanoma compared with NHW individuals. Etiologic and cancer outcomes research among H/Ls lags other populations. In this review, we provide a summary of challenges, opportunities, and research priorities related to cancer etiology, cancer outcomes, and survivorship to make progress in addressing scientific gaps. Briefly, we prioritize the need for more research on determinants of obesity, nonalcoholic fatty liver disease and its progression to liver cancer, stomach and gallbladder cancers, and pediatric acute lymphoblastic leukemia. We emphasize the need to improve cancer screening, early detection of cancer, and survivorship care. We highlight critical resources needed to make progress in cancer epidemiologic studies among H/L populations, including the importance of training the next generation of cancer epidemiologists conducting research in H/Ls.
Collapse
Affiliation(s)
- Laura Fejerman
- Department of Public Health Sciences, UC Davis Comprehensive Cancer Center, University of California Davis, Davis, California
| | - Amelie G Ramirez
- Department of Population Health Sciences, School of Medicine, Mays Cancer Center, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Anna María Nápoles
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, NIH, Bethesda, Maryland
| | - Scarlett Lin Gomez
- Department of Epidemiology and Biostatistics, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California
| | - Mariana C Stern
- Department of Population and Public Health Sciences, Department of Urology, Keck School of Medicine of USC, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| |
Collapse
|
24
|
Bang B, Eisfeldt J, Barbany G, Harila-Saari A, Heyman M, Zachariadis V, Taylan F, Nordgren A. A somatic UBA2 variant preceded ETV6-RUNX1 in the concordant BCP-ALL of monozygotic twins. Blood Adv 2022; 6:2275-2289. [PMID: 34982829 PMCID: PMC9006272 DOI: 10.1182/bloodadvances.2021005703] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/06/2021] [Indexed: 11/24/2022] Open
Abstract
Genetic analysis of leukemic clones in monozygotic twins with concordant acute lymphoblastic leukemia (ALL) has proved a unique opportunity to gain insight into the molecular phylogenetics of leukemogenesis. Using whole-genome sequencing, we characterized constitutional and somatic single nucleotide variants/insertion-deletions (indels) and structural variants in a monozygotic twin pair with concordant ETV6-RUNX1+ B-cell precursor ALL (BCP-ALL). In addition, digital PCR (dPCR) was applied to evaluate the presence of and quantify selected somatic variants at birth, diagnosis, and remission. A shared somatic complex rearrangement involving chromosomes 11, 12, and 21 with identical fusion sequences in leukemias of both twins offered direct proof of a common clonal origin. The ETV6-RUNX1 fusion detected at diagnosis was found to originate from this complex rearrangement. A shared somatic frameshift deletion in UBA2 was also identified in diagnostic samples. In addition, each leukemia independently acquired analogous deletions of 3 genes recurrently targeted in BCP-ALLs (ETV6, ATF7IP, and RAG1/RAG2), providing evidence of a convergent clonal evolution only explained by a strong concurrent selective pressure. Quantification of the UBA2 deletion by dPCR surprisingly indicated it persisted in remission. This, for the first time to our knowledge, provided evidence of a UBA2 variant preceding the well-established initiating event ETV6-RUNX1. Further, we suggest the UBA2 deletion exerted a leukemia predisposing effect and that its essential role in Small Ubiquitin-like Modifier (SUMO) attachment (SUMOylation), regulating nearly all physiological and pathological cellular processes such as DNA-repair by nonhomologous end joining, may hold a mechanistic explanation for the predisposition.
Collapse
Affiliation(s)
- Benedicte Bang
- Department of Molecular Medicine and Surgery, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jesper Eisfeldt
- Department of Molecular Medicine and Surgery, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Gisela Barbany
- Department of Molecular Medicine and Surgery, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Arja Harila-Saari
- Department of Women’s and Children’s Health, Uppsala University Hospital, Uppsala, Sweden
| | - Mats Heyman
- Department of Women’s and Children’s Health, Karolinska University Hospital Solna, Stockholm, Sweden; and
| | - Vasilios Zachariadis
- Department of Oncology-Pathology, Cancer Centre Karolinska (CCK), Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
| | - Fulya Taylan
- Department of Molecular Medicine and Surgery, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Ann Nordgren
- Department of Molecular Medicine and Surgery, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
25
|
Jeon S, de Smith AJ, Li S, Chen M, Chan TF, Muskens IS, Morimoto LM, DeWan AT, Mancuso N, Metayer C, Ma X, Wiemels JL, Chiang CWK. Genome-wide trans-ethnic meta-analysis identifies novel susceptibility loci for childhood acute lymphoblastic leukemia. Leukemia 2022; 36:865-868. [PMID: 34750507 PMCID: PMC9075725 DOI: 10.1038/s41375-021-01465-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/12/2021] [Accepted: 10/21/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Soyoung Jeon
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Cancer Biology and Genomics Graduate Program, Program in Biological and Biomedical Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Adam J de Smith
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Shaobo Li
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Cancer Biology and Genomics Graduate Program, Program in Biological and Biomedical Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Minhui Chen
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Tsz Fung Chan
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ivo S Muskens
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Libby M Morimoto
- Division of Epidemiology & Biostatistics, School of Public Health, University of California, Berkeley, CA, USA
| | - Andrew T DeWan
- Center for Perinatal, Pediatric and Environmental Epidemiology, Yale School of Public Health, New Haven, CT, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Nicholas Mancuso
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Quantitative and Computational Biology, University of Southern California, Los Angeles, CA, USA
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Catherine Metayer
- Division of Epidemiology & Biostatistics, School of Public Health, University of California, Berkeley, CA, USA
| | - Xiaomei Ma
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Joseph L Wiemels
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Charleston W K Chiang
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
- Department of Quantitative and Computational Biology, University of Southern California, Los Angeles, CA, USA.
| |
Collapse
|
26
|
Kwan ML, Miglioretti DL, Bowles EJA, Weinmann S, Greenlee RT, Stout NK, Rahm AK, Alber SA, Pequeno P, Moy LM, Stewart C, Fong C, Jenkins CL, Kohnhorst D, Luce C, Mor JM, Munneke JR, Prado Y, Buth G, Cheng SY, Deosaransingh KA, Francisco M, Lakoma M, Martinez YT, Theis MK, Marlow EC, Kushi LH, Duncan JR, Bolch WE, Pole JD, Smith-Bindman R. Quantifying cancer risk from exposures to medical imaging in the Risk of Pediatric and Adolescent Cancer Associated with Medical Imaging (RIC) Study: research methods and cohort profile. Cancer Causes Control 2022; 33:711-726. [PMID: 35107724 DOI: 10.1007/s10552-022-01556-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 01/18/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE The Risk of Pediatric and Adolescent Cancer Associated with Medical Imaging (RIC) Study is quantifying the association between cumulative radiation exposure from fetal and/or childhood medical imaging and subsequent cancer risk. This manuscript describes the study cohorts and research methods. METHODS The RIC Study is a longitudinal study of children in two retrospective cohorts from 6 U.S. healthcare systems and from Ontario, Canada over the period 1995-2017. The fetal-exposure cohort includes children whose mothers were enrolled in the healthcare system during their entire pregnancy and followed to age 20. The childhood-exposure cohort includes children born into the system and followed while continuously enrolled. Imaging utilization was determined using administrative data. Computed tomography (CT) parameters were collected to estimate individualized patient organ dosimetry. Organ dose libraries for average exposures were constructed for radiography, fluoroscopy, and angiography, while diagnostic radiopharmaceutical biokinetic models were applied to estimate organ doses received in nuclear medicine procedures. Cancers were ascertained from local and state/provincial cancer registry linkages. RESULTS The fetal-exposure cohort includes 3,474,000 children among whom 6,606 cancers (2394 leukemias) were diagnosed over 37,659,582 person-years; 0.5% had in utero exposure to CT, 4.0% radiography, 0.5% fluoroscopy, 0.04% angiography, 0.2% nuclear medicine. The childhood-exposure cohort includes 3,724,632 children in whom 6,358 cancers (2,372 leukemias) were diagnosed over 36,190,027 person-years; 5.9% were exposed to CT, 61.1% radiography, 6.0% fluoroscopy, 0.4% angiography, 1.5% nuclear medicine. CONCLUSION The RIC Study is poised to be the largest study addressing risk of childhood and adolescent cancer associated with ionizing radiation from medical imaging, estimated with individualized patient organ dosimetry.
Collapse
Affiliation(s)
- Marilyn L Kwan
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.
| | - Diana L Miglioretti
- Department of Public Health Sciences, University of California, Davis, CA, USA.,Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Erin J A Bowles
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Sheila Weinmann
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA.,Center for Integrated Health Research, Kaiser Permanente Hawaii, Honolulu, HI, USA
| | - Robert T Greenlee
- Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, WI, USA
| | - Natasha K Stout
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Alanna Kulchak Rahm
- Center for Health Research, Genomic Medicine Institute, Geisinger, Danville, PA, USA
| | - Susan A Alber
- Department of Public Health Sciences, University of California, Davis, CA, USA
| | | | - Lisa M Moy
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Carly Stewart
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | | | - Charisma L Jenkins
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Diane Kohnhorst
- Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, WI, USA
| | - Casey Luce
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Joanne M Mor
- Center for Integrated Health Research, Kaiser Permanente Hawaii, Honolulu, HI, USA
| | - Julie R Munneke
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Yolanda Prado
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Glen Buth
- Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, WI, USA
| | | | - Kamala A Deosaransingh
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Melanie Francisco
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Matthew Lakoma
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | | | - Mary Kay Theis
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Emily C Marlow
- Department of Public Health Sciences, University of California, Davis, CA, USA
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - James R Duncan
- Interventional Radiology Section, Washington University in St. Louis, St. Louis, MI, USA
| | - Wesley E Bolch
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Jason D Pole
- ICES, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Rebecca Smith-Bindman
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.,Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| |
Collapse
|
27
|
Beltrami A, Hilliard A, Green AL. Demographic and socioeconomic disparities in pediatric cancer in the United States: Current knowledge, deepening understanding, and expanding intervention. Cancer Epidemiol 2021; 76:102082. [PMID: 34923289 DOI: 10.1016/j.canep.2021.102082] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 01/19/2023]
Abstract
While survival of pediatric cancer has improved greatly over the past 40 years, demographic and socioeconomic disparities have meant that some groups have not benefitted as much from these advances. We conducted a rapid review to summarize literature on demographic and socioeconomic disparities in outcomes of childhood cancer, starting in 2000. We find that unequal outcomes have been noted for many of these groups across hematologic malignancies, central nervous system tumors, and other solid tumors, although occasional studies have noted absence of disparities for particular at-risk groups and diseases, and gaps in understanding of disparities for some cancer subtypes and groups still exist. These include disparities in duration of overall survival, risk of death, more extensive disease at presentation, and differences/delays in treatment. Black race, Hispanic ethnicity, lack of private insurance, and adolescent/young adult age are most often associated with these poorer outcomes. We then delve into documented and theorized causes of these disparities, including impaired access to care and clinical trials, differences in cancer biology, treatment non-adherence, language barriers, and implicit racial bias. Here, it is clear that socioeconomic factors account for a large proportion of disparities seen, although not all, and that the causes of disparities are complex and interconnected and still need to be better understood. Finally, in an effort to shift emphasis to addressing disparities, we review interventions against disparities that have been studied in childhood cancer patients and other populations, including improving clinical trial representation, communication, health literacy, and family navigation. We suggest ways forward in disparity mitigation toward a goal of achieving equitable cancer outcomes for all children.
Collapse
Affiliation(s)
- Alina Beltrami
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States; Department of Biological Sciences, University of Denver, Denver, CO, United States
| | - Alexandra Hilliard
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States; Department of Biological Sciences, University of Denver, Denver, CO, United States
| | - Adam L Green
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States; Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, CO, United States.
| |
Collapse
|
28
|
Johnston EE, Martinez I, Davis ES, Caudill C, Richman J, Brackett J, Dickens DS, Kahn A, Schwalm C, Sharma A, Patel PA, Bhatia S, Levine JM, Wolfson JA. SARS-CoV-2 in Childhood Cancer in 2020: A Disease of Disparities. J Clin Oncol 2021; 39:3778-3788. [PMID: 34694886 PMCID: PMC8608263 DOI: 10.1200/jco.21.00702] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The Pediatric Oncology COVID-19 Case Report registry supplies pediatric oncologists with data surrounding the clinical course and outcomes in children with cancer and SARS-CoV-2. METHODS This observational study captured clinical and sociodemographic characteristics for children (≤ 21 years) receiving cancer therapy and infected with SARS-CoV-2 from the pandemic onset through February 19, 2021. The demographic and clinical characteristics of the cohort were compared with population-level pediatric oncology data (SEER). Multivariable binomial regression models evaluated patient characteristics associated with hospitalization, intensive care unit (ICU) admission, and changes in cancer therapy. RESULTS Ninety-four institutions contributed details on 917 children with cancer and SARS-CoV-2. Median age at SARS-CoV-2 infection was 11 years (range, 0-21 years). Compared with SEER, there was an over-representation of Hispanics (43.6% v 29.7%, P < .01), publicly insured (59.3% v 33.5%, P < .01), and patients with hematologic malignancies (65.8% v 38.3%, P < .01) in our cohort. The majority (64.1%) were symptomatic; 31.2% were hospitalized, 10.9% required respiratory support, 9.2% were admitted to the ICU, and 1.6% died because of SARS-CoV-2. Cancer therapy was modified in 44.9%. Hispanic ethnicity was associated with changes in cancer-directed therapy (adjusted risk ratio [aRR] = 1.3; 95% CI, 1.1 to 1.6]). Presence of comorbidities was associated with hospitalization (aRR = 1.3; 95% CI, 1.1 to 1.6) and ICU admission (aRR = 2.3; 95% CI, 1.5 to 3.6). Hematologic malignancies were associated with hospitalization (aRR = 1.6; 95% CI, 1.3 to 2.1). CONCLUSION These findings provide critical information for decision making among pediatric oncologists, including inpatient versus outpatient management, cancer therapy modifications, consideration of monoclonal antibody therapy, and counseling families on infection risks in the setting of the SARS-CoV-2 pandemic. The over-representation of Hispanic and publicly insured patients in this national cohort suggests disparities that require attention.
Collapse
Affiliation(s)
- Emily E Johnston
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.,Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
| | - Isaac Martinez
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Elizabeth S Davis
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Caroline Caudill
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Joshua Richman
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.,Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Julienne Brackett
- Pediatric Hematology-Oncology, Department of Pediatrics, Texas Children's Hospital, Houston, TX
| | - David S Dickens
- Pediatric Hematology-Oncology, Department of Pediatrics, University of Iowa, Iowa City, IA
| | - Alissa Kahn
- Pediatric Hematology-Oncology, Department of Pediatrics, Saint Joseph's University Medical Center, Paterson, NJ
| | - Carla Schwalm
- Pediatric Hematology-Oncology, Department of Pediatrics, Bronson Methodist Hospital, Kalamazoo, MI
| | - Archana Sharma
- Pediatric Hematology-Oncology, Department of Pediatrics, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Pratik A Patel
- Pediatric Hematology-Oncology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.,Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
| | - Jennifer M Levine
- Pediatric Hematology-Oncology, Department of Pediatrics, Weill Cornell Medicine, New York, NY
| | - Julie A Wolfson
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.,Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
| | | |
Collapse
|
29
|
Quiroz E, Venkateswaran AR, Nelson R, Aldoss I, Pullarkat V, Rego E, Marcucci G, Douer D. Immunophenotype of acute lymphoblastic leukemia in minorities- analysis from the SEER database. Hematol Oncol 2021; 40:105-110. [PMID: 34766363 DOI: 10.1002/hon.2945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/08/2021] [Accepted: 10/24/2021] [Indexed: 11/07/2022]
Abstract
Acute Lymphocytic Leukemia (ALL) is a malignancy that originates from immature lymphoid cells and is clinically established with flow cytometry through disease-specific markers. Variation between ethnic groups is an epidemiological aspect of ALL. Higher incidence rates have been observed in Latin American patients and ALL in Latinos carries a dismal prognosis. The cell of origin in ALL is derived from immature cells of either the B or T lineage. Most reported data among Latinos either exclusively looks at B cell precursor ALL or do not distinguish between subtypes. We used the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database to delineate the differences in incidence rates of B-ALL and T-ALL across ethnic groups in the United States. Data from SEER-18 was used to compare incidence rates of T-ALL and B-ALL. Due to the utilization of cytogenetics and subsequent changes in ICD coding over the years examined the most recent data reported from 2002 to 2017. We compared rates in Non-Hispanic Whites (NHWs), Latinos, Blacks and Asian-Pacific Islanders (API). Age-adjusted incidence rates per 100,000 person-years were calculated. The incidence rate of B-ALL in the Latino population was consistently higher than other race/ethnicities throughout the years, ranging from 1.0 per 100,000 in 2002 to 2.5 per 100,000 in 2017. Blacks had the lowest age adjusted incidence rate (AAIR) of B-ALL overall, with rates approximately one third of those found in Latinos and the highest AAIR of T-ALL with an AAIR of 0.5 per 100,000.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Dan Douer
- University of Southern California, Los Angeles, California, USA
| |
Collapse
|
30
|
Miller KD, Ortiz AP, Pinheiro PS, Bandi P, Minihan A, Fuchs HE, Martinez Tyson D, Tortolero-Luna G, Fedewa SA, Jemal AM, Siegel RL. Cancer statistics for the US Hispanic/Latino population, 2021. CA Cancer J Clin 2021; 71:466-487. [PMID: 34545941 DOI: 10.3322/caac.21695] [Citation(s) in RCA: 158] [Impact Index Per Article: 52.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/04/2021] [Indexed: 01/03/2023] Open
Abstract
The Hispanic/Latino population is the second largest racial/ethnic group in the continental United States and Hawaii, accounting for 18% (60.6 million) of the total population. An additional 3 million Hispanic Americans live in Puerto Rico. Every 3 years, the American Cancer Society reports on cancer occurrence, risk factors, and screening for Hispanic individuals in the United States using the most recent population-based data. An estimated 176,600 new cancer cases and 46,500 cancer deaths will occur among Hispanic individuals in the continental United States and Hawaii in 2021. Compared to non-Hispanic Whites (NHWs), Hispanic men and women had 25%-30% lower incidence (2014-2018) and mortality (2015-2019) rates for all cancers combined and lower rates for the most common cancers, although this gap is diminishing. For example, the colorectal cancer (CRC) incidence rate ratio for Hispanic compared with NHW individuals narrowed from 0.75 (95% CI, 0.73-0.78) in 1995 to 0.91 (95% CI, 0.89-0.93) in 2018, reflecting delayed declines in CRC rates among Hispanic individuals in part because of slower uptake of screening. In contrast, Hispanic individuals have higher rates of infection-related cancers, including approximately two-fold higher incidence of liver and stomach cancer. Cervical cancer incidence is 32% higher among Hispanic women in the continental US and Hawaii and 78% higher among women in Puerto Rico compared to NHW women, yet is largely preventable through screening. Less access to care may be similarly reflected in the low prevalence of localized-stage breast cancer among Hispanic women, 59% versus 67% among NHW women. Evidence-based strategies for decreasing the cancer burden among the Hispanic population include the use of culturally appropriate lay health advisors and patient navigators and targeted, community-based intervention programs to facilitate access to screening and promote healthy behaviors. In addition, the impact of the COVID-19 pandemic on cancer trends and disparities in the Hispanic population should be closely monitored.
Collapse
Affiliation(s)
- Kimberly D Miller
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Ana P Ortiz
- Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Paulo S Pinheiro
- Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, Florida
| | - Priti Bandi
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Adair Minihan
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Hannah E Fuchs
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | | | - Guillermo Tortolero-Luna
- Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Stacey A Fedewa
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Ahmedin M Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Rebecca L Siegel
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| |
Collapse
|
31
|
Genetic ancestry and skeletal toxicities among childhood acute lymphoblastic leukemia patients in the DFCI 05-001 cohort. Blood Adv 2021; 5:451-458. [PMID: 33496737 DOI: 10.1182/bloodadvances.2020003060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/17/2020] [Indexed: 11/20/2022] Open
Abstract
Hispanic children have a higher incidence of acute lymphoblastic leukemia (ALL) and inferior treatment outcomes relative to non-Hispanic White children. We previously reported that Hispanic children with ALL had lower risk of fracture and osteonecrosis. To unravel the genetic root of such ethnic differences, we genotyped 449 patients from the DFCI 05-001 cohort and analyzed their ancestry. Patients with discordant clinical and genetic ancestral groups were reclassified, and those with unknown ancestry were reassigned on the basis of genetic estimates. Both clinical and genetic ancestries were analyzed in relation to risk of bone toxicities and survival outcomes. Consistent with clinically reported race/ethnicity, genetically defined Hispanic and Black patients had significantly lower risk of fracture (Hispanic: subdistribution hazard ratio [SHR], 0.42; 95% confidence interval [CI], 0.22-0.81; P = .01; Black: SHR, 0.28; 95% CI, 0.10-0.75; P = .01), and osteonecrosis (Hispanic: SHR, 0.12; 95% CI, 0.02-0.93; P = .04; Black: SHR, 0.24; 95% CI, 0.08-0.78; P = .02). The lower risk was driven by African but not Native American or Asian ancestry. In addition, patients with a higher percentage of Native American ancestry had significantly poorer overall survival and event-free survival. Our study revealed that the lower risk of bone toxicities among Black and Hispanic children treated for ALL was attributed, in part, to the percentage of African ancestry in their genetic admixture. The findings provide suggestive evidence for the protective effects of genetic factors associated with African decent against bone damage caused by ALL treatment and clues for future studies to identify underlying biological mechanisms.
Collapse
|
32
|
Inaba H, Pui CH. Advances in the Diagnosis and Treatment of Pediatric Acute Lymphoblastic Leukemia. J Clin Med 2021; 10:1926. [PMID: 33946897 PMCID: PMC8124693 DOI: 10.3390/jcm10091926] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/20/2021] [Accepted: 04/25/2021] [Indexed: 12/12/2022] Open
Abstract
The outcomes of pediatric acute lymphoblastic leukemia (ALL) have improved remarkably during the last five decades. Such improvements were made possible by the incorporation of new diagnostic technologies, the effective administration of conventional chemotherapeutic agents, and the provision of better supportive care. With the 5-year survival rates now exceeding 90% in high-income countries, the goal for the next decade is to improve survival further toward 100% and to minimize treatment-related adverse effects. Based on genome-wide analyses, especially RNA-sequencing analyses, ALL can be classified into more than 20 B-lineage subtypes and more than 10 T-lineage subtypes with prognostic and therapeutic implications. Response to treatment is another critical prognostic factor, and detailed analysis of minimal residual disease can detect levels as low as one ALL cell among 1 million total cells. Such detailed analysis can facilitate the rational use of molecular targeted therapy and immunotherapy, which have emerged as new treatment strategies that can replace or reduce the use of conventional chemotherapy.
Collapse
Affiliation(s)
- Hiroto Inaba
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA;
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA;
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| |
Collapse
|
33
|
Bencomo-Alvarez AE, Rubio AJ, Gonzalez MA, Eiring AM. Blood cancer health disparities in the United States Hispanic population. Cold Spring Harb Mol Case Stud 2021; 7:a005967. [PMID: 33593728 PMCID: PMC8040735 DOI: 10.1101/mcs.a005967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Cancer is a challenging, multifaceted disease that involves a combination of biological and nonbiological factors. Aside from COVID-19, cancer is the second leading cause of death in the United States and the first among Hispanic Americans. The Hispanic population is the largest minority group in the United States, which is rapidly growing in size. Unfortunately, U.S. Hispanics and other minority groups experience many different health disparities, resulting in poor survival outcomes and a reduced quality of life. Factors such as genomic mutations, lower socioeconomic status, lack of education, reduced access to health care, comorbidities, and environmental factors all contribute to these health-care inequalities. In the context of blood cancer health disparities, Hispanic patients are often diagnosed at a younger age and have worse outcomes compared with non-Hispanic individuals. In this commentary, we highlight the existing knowledge about cancer health disparities in the Hispanic population, with a focus on chronic and acute leukemia. In our experience at the U.S./Mexican border, analysis of several different blood cancers demonstrated that younger Hispanic patients with acute lymphoid or myeloid leukemia have higher incidence rates and worse prognoses. A combined approach, involving improved health-care access and better knowledge of the underlying factors, will allow for more timely diagnoses and the development of intervention strategies aimed at reducing or eliminating the disparities.
Collapse
Affiliation(s)
- Alfonso E Bencomo-Alvarez
- Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas 79905, USA
| | - Andres J Rubio
- Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas 79905, USA
| | - Mayra A Gonzalez
- Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas 79905, USA
| | - Anna M Eiring
- Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas 79905, USA
| |
Collapse
|
34
|
Wolfson JA. Poverty and Survival in Childhood Cancer: A Framework to Move Toward Systemic Change. J Natl Cancer Inst 2021; 113:227-230. [PMID: 33227815 DOI: 10.1093/jnci/djaa108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 07/24/2020] [Indexed: 12/30/2022] Open
Affiliation(s)
- Julie Anna Wolfson
- Division of Pediatric Hematology-Oncology, Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
35
|
Rosales-Rodríguez B, Núñez-Enríquez JC, Velázquez-Wong AC, González-Torres C, Gaytán-Cervantes J, Jiménez-Hernández E, Martín-Trejo JA, Campo-Martínez MDLÁD, Medina-Sanson A, Flores-Lujano J, Flores-Villegas LV, Peñaloza-González JG, Torres-Nava JR, Espinosa-Elizondo RM, Amador-Sánchez R, Miranda-Madrazo MR, Santillán-Juárez JD, Pérez-Saldívar ML, Gurrola-Silva A, Orozco-Ruiz D, Solís-Labastida KA, Velázquez-Aviña MM, Duarte-Rodríguez DA, Mata-Rocha M, Sepúlveda-Robles OA, Ortiz-Maganda M, Bekker-Méndez VC, Jiménez-Morales S, Mejía-Aranguré JM, Rosas-Vargas H. Copy Number Alterations are Associated with the Risk of Very Early Relapse in Pediatric B-lineage Acute Lymphoblastic Leukemia: A Nested Case-control MIGICCL Study. Arch Med Res 2021; 52:414-422. [PMID: 33541741 DOI: 10.1016/j.arcmed.2020.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/30/2020] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Refining risk stratification to avoid very early relapses (VER) in Mexican patients with B-lineage acute lymphoblastic leukemia (B-ALL) could lead to better survival rates in our population. AIM OF THE STUDY The purpose of this study was to investigate the association between the United Kingdom ALL (UKALL)-CNA classifier and VER risk in Mexican patients with childhood B-ALL. METHODS A nested case-control study of 25 cases with VER and 38 frequency-matched controls without relapse was conducted within the MIGICCL study cohort. They were grouped into the categories of the UKALL-CNA risk classifier (good [reference], intermediate and poor), according to the results obtained by multiplex ligation dependent probe amplification. Overall and disease-free survival (DFS) were estimated using the Kaplan-Meier method. Univariate and multivariate Cox proportional hazards analyses were conducted. RESULTS The CDKN2A/B genes were most frequently deleted in the group with relapse. According to UKALL-CNA classifier, 33 (52.4%) patients were classified as good, 21 (33.3%) intermediate and 9 (14.3%) poor-risk B-ALL. The intermediate and poor risk groups were associated with an increased risk of VER (HR = 4.94, 95% CI = 1.87-13.07 and HR = 7.42, 95% CI = 2.37-23.26, respectively) in comparison to the good-risk patients. After adjusting by NCI risk classification and chemotherapy scheme in a multivariate model, the risks remained significant. CONCLUSIONS Our data support the clinical utility of profiling CNAs to potentially refine current risk stratification strategies of patients with B-ALL.
Collapse
Affiliation(s)
- Beatriz Rosales-Rodríguez
- Programa de Doctorado, Posgrado en Ciencias Biológicas, Universidad Nacional Autónoma de México, Ciudad de México, México; Unidad de Investigación Médica en Genética Humana, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Juan Carlos Núñez-Enríquez
- Unidad de Investigación Médica en Epidemiología Clínica, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Ana Claudia Velázquez-Wong
- Unidad de Investigación Médica en Genética Humana, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Carolina González-Torres
- Laboratorio de Secuenciación, División de Desarrollo de la Investigación, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Javier Gaytán-Cervantes
- Laboratorio de Secuenciación, División de Desarrollo de la Investigación, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Elva Jiménez-Hernández
- Coordinación de Investigación en Salud, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México; Servicio de Hematología Pediátrica, Hospital General Gaudencio González Garza, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Jorge Alfonso Martín-Trejo
- Servicio de Hematología, Unidad de Investigación Médica en Epidemiología Clínica, Hospital de Pediatría, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - María de Los Ángeles Del Campo-Martínez
- Servicio de Hematología Pediátrica, Hospital General Gaudencio González Garza, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Aurora Medina-Sanson
- Servicio de Hemato-Oncología, Hospital Infantil de México Federico Gómez, Secretaria de Salud, Ciudad de México, México
| | - Janet Flores-Lujano
- Unidad de Investigación Médica en Epidemiología Clínica, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Luz Victoria Flores-Villegas
- Servicio de Hematología Pediátrica, Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad Social al Servicio de los Trabajadores del Estado, Ciudad de México, México
| | | | - José Refugio Torres-Nava
- Servicio de Oncología, Hospital Pediátrico Moctezuma, Secretaría de Salud de la Ciudad de México, Ciudad de México, México
| | | | - Raquel Amador-Sánchez
- Servicio de Hematología Pediátrica, Hospital General Regional No. 1 Dr. Carlos MacGregor Sánchez Navarro, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - María Raquel Miranda-Madrazo
- Servicio de Hematología Pediátrica, Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad Social al Servicio de los Trabajadores del Estado, Ciudad de México, México
| | - Jessica Denise Santillán-Juárez
- Servicio de Hemato-Oncología Pediátrica, Hospital Regional No. 1° de Octubre, Instituto de Seguridad Social al Servicio de los Trabajadores del Estado, Ciudad de México, México
| | - María Luisa Pérez-Saldívar
- Unidad de Investigación Médica en Epidemiología Clínica, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Alma Gurrola-Silva
- Servicio de Pediatría, Hospital Regional Tipo B de Alta Especialidad Bicentenario de la Independencia, Instituto de Seguridad Social al Servicio de los Trabajadores del Estado, Ciudad de México, México
| | - Darío Orozco-Ruiz
- Servicio de Oncología, Hospital Pediátrico Moctezuma, Secretaría de Salud de la Ciudad de México, Ciudad de México, México
| | - Karina Anastacia Solís-Labastida
- Servicio de Hematología, Unidad de Investigación Médica en Epidemiología Clínica, Hospital de Pediatría, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | | | - David Aldebarán Duarte-Rodríguez
- Unidad de Investigación Médica en Epidemiología Clínica, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Minerva Mata-Rocha
- Unidad de Investigación Médica en Genética Humana, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México; Coordinación de Investigación en Salud, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Omar Alejandro Sepúlveda-Robles
- Unidad de Investigación Médica en Genética Humana, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México; Coordinación de Investigación en Salud, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Mónica Ortiz-Maganda
- Unidad de Investigación Médica en Inmunología e Infectología, Hospital de Infectología Dr. Daniel Méndez Hernández, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Vilma Carolina Bekker-Méndez
- Unidad de Investigación Médica en Inmunología e Infectología, Hospital de Infectología Dr. Daniel Méndez Hernández, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Silvia Jiménez-Morales
- Laboratorio de Genómica del Cáncer, Instituto Nacional de Medicina Genómica, Ciudad de México, México
| | - Juan Manuel Mejía-Aranguré
- Coordinación de Investigación en Salud, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Haydeé Rosas-Vargas
- Unidad de Investigación Médica en Genética Humana, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.
| |
Collapse
|
36
|
Diversity of genetic alterations of primary central nervous system lymphoma in Hispanic versus non-Hispanic patients. Cancer Treat Res Commun 2021; 27:100310. [PMID: 33581493 DOI: 10.1016/j.ctarc.2021.100310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 01/02/2021] [Accepted: 01/08/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE Primary central nervous system lymphoma (PCNSL) is a rare type of non-Hodgkin lymphoma. Previous studies have identified MYD88, CD79b and PIM1 as the most common genetic mutations in PCNSL. The extent to which mutations vary by ethnicity is unknown. The purpose of this study was to describe differences in genetic mutations and survival by Hispanic ethnicity in PCNSL. METHODS 30 patients with PCNSL were examined for mutations in 275 genes by DNA analysis and 1408 genes by RNA analysis utilizing next generation sequencing. RESULTS 60% of patients were Hispanic. 125 different mutated genes were detected. The most commonly affected genes were: MYD88 (44%), CARD11 (21%), CD79b (17%), PIM1 (17%) and KMT2D (17%) . MYD88 mutation was less frequent in Hispanic patients (27% vs 66%, P=.02). More Hispanic patients had >3 mutated genes (89% vs 55 %. P=.03). Two-year progression-free survival (PFS) and overall survival (OS) in Hispanic vs. non-Hispanic patients (PFS 60% vs 27%, P=.09), (OS 60% vs 36%, P=.23). MYD88, CARD11, PIM1, and KMT2D were not associated with significant differences in OS or PFS. CD79b mutation correlated with superior 2-yr PFS (P=.04). CONCLUSIONS We identified highly recurrent genetic alterations in PCNSL. Our data suggest that heterogeneity in some mutations may be related to ethnicity. There was no statistically significant difference in 2-yr PFS and OS in our Hispanic patients. Studies on larger population may further help to describe differences in tumor biology, and outcomes in Hispanic patients.
Collapse
|
37
|
Magatha LS, Scott JX, Subramaniam G, Chandrasekaran T, Paul SFD, Koshy T. Cytogenetic and Fluorescence in situ Hybridization Profile of Pediatric Acute Lymphoblastic Leukemia in a University Hospital in South India. Med Princ Pract 2021; 30:563-570. [PMID: 34348305 PMCID: PMC8739856 DOI: 10.1159/000518280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 07/04/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the cytogenetic and fluorescent in situ hybridization (FISH) profile in children with acute lymphoblastic leukemia (ALL), referred to a university hospital in a 5-year 6-month period. SUBJECTS AND METHODS Cytogenetic analysis of the bone marrow aspirate specimens of 91 patients was performed by standard Giemsa (G)-banding and interphase FISH (iFISH). RESULTS The frequency of chromosomal abnormalities detected by G-banding was 29.5%, and the frequency of nonrandom abnormalities with independent prognostic significance identified by iFISH was 46.4%. The abnormality with the highest frequency was gain of RUNX1 (n = 18, 21.4%), followed by ETV6/RUNX1 fusion (n = 7, 8.3%), and gain of KMT2A (n = 6, 7.1%). Additionally, rarely reported gains of ETV6, PBX1, and ABL1 were observed at a frequency of 6% (n = 5), and the deletion of ETV6 and TCF3 was seen at a frequency of 3.6% (n = 3) and 2.3% (n = 2), respectively. A 10-year old with intrachromosomal amplification of chromosome 21 was also observed. CONCLUSIONS This study strengthens and widens the current knowledge of the cytogenetic landscape of pediatric ALL.
Collapse
Affiliation(s)
- Latha Sneha Magatha
- Division of Pediatric Hemato-oncology, Department of Pediatrics, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Julius Xavier Scott
- Division of Pediatric Hemato-oncology, Department of Pediatrics, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Gayathri Subramaniam
- Department of Human Genetics, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Thirugnanasambandan Chandrasekaran
- Division of Pediatric Hemato-oncology, Department of Pediatrics, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | | | - Teena Koshy
- Department of Human Genetics, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
- *Teena Koshy,
| |
Collapse
|
38
|
Haizel-Cobbina J, Spector LG, Moertel C, Parsons HM. Racial and ethnic disparities in survival of children with brain and central nervous tumors in the United States. Pediatr Blood Cancer 2021; 68:e28738. [PMID: 32970937 DOI: 10.1002/pbc.28738] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Despite improvements in overall survival for pediatric cancers, treatment disparities remain for racial/ethnic minorities compared to non-Hispanic Whites; however, the impact of race on treatment outcomes for pediatric brain and central nervous system (CNS) tumors in the United States is not well known. METHODS We included 8713 children aged 0-19 years with newly diagnosed primary brain and CNS tumors between 2000 and 2015 from the Census Tract-level SES and Rurality Database developed by Surveillance, Epidemiology, and End Results (SEER) Program. We used chi-square tests to assess differences in sociodemographic, cancer, and treatment characteristics by race/ethnicity and Kaplan-Meier curves and Cox proportional hazards models to examine differences in 10-year survival, adjusting for these characteristics. RESULTS Among 8713 patients, 56.75% were non-Hispanic White, 9.59% non-Hispanic Black, 25.46% Hispanic, and 8.19% from "other" racial/ethnic groups. Median unadjusted survival for all pediatric brain tumors was 53 months, but varied significantly by race/ethnicity with a median survival of 62 months for non-Hispanic Whites, 41 months for non-Hispanic Blacks, and 40 months for Hispanic and other. Multivariable analyses demonstrated minority racial groups still had significantly higher hazard of death than non-Hispanic Whites; Hispanic (adjusted hazard ratio [aHR] 1.25 [1.18-1.31]); non-Hispanic Black (aHR 1.12 [1.04-1.21]); other (aHR 1.22 [1.12-1.32]). Results were consistent when stratified by tumor histology. CONCLUSION We identified disparities in survival among racial/ethnic minorities with pediatric brain and CNS tumors, with Hispanic patients having the highest risk of mortality. Eliminating these disparities requires commitment toward promoting heath equity and personalized cancer treatment.
Collapse
Affiliation(s)
| | - Logan G Spector
- Division of Pediatric Epidemiology and Clinical Research, University of Minnesota, Minneapolis, Minnesota
| | - Christopher Moertel
- Division of Pediatric Hematology and Oncology, University of Minnesota, Minneapolis, Minnesota
| | - Helen M Parsons
- Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota
| |
Collapse
|
39
|
Abstract
Pediatric acute lymphoblastic leukemia (ALL) is defined by recurrent chromosomal aberrations including hyperdiploidy and chromosomal translocations. Many of these aberrations originate in utero and the cells transform in early childhood through acquired secondary mutations. In this review, we will discuss the most common prenatal lesions that can lead to childhood ALL, with a special emphasis on the most common translocation in childhood ALL, t(12;21), which results in the ETV6-RUNX1 gene fusion. The ETV6-RUNX1 fusion arises prenatally and at a 500-fold higher frequency than the corresponding ALL. Even though the findings regarding the frequency of ETV6-RUNX1 were originally challenged, newer studies have confirmed the higher frequency. The prenatal origin has also been proven for other gene fusions, including KMT2A, the translocations t(1;19) and t(9;22) leading to TCF3-PBX1 and BCR-ABL1, respectively, as well as high hyperdiploidy. For most of these aberrations, there is evidence for more frequent occurrence than the corresponding leukemia incidences. We will briefly discuss what is known about the cells of origin, the mechanisms of leukemic transformation through lack of immunosurveillance, and why only a part of the carriers develops ALL.
Collapse
Affiliation(s)
- Daniel Hein
- Department of Pediatric Oncology, Hematology and Clinical Immunology, University Children's Hospital, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Arndt Borkhardt
- Department of Pediatric Oncology, Hematology and Clinical Immunology, University Children's Hospital, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
| | - Ute Fischer
- Department of Pediatric Oncology, Hematology and Clinical Immunology, University Children's Hospital, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| |
Collapse
|
40
|
Cardoso de Carvalho D, Pereira Colares Leitão L, Mello Junior FAR, Vieira Wanderley A, de Souza TP, Borges Andrade de Sá R, Cohen-Paes A, Rodrigues Fernandes M, Santos S, Salim Khayat A, Pimentel de Assumpção P, Pereira Carneiro dos Santos N. Association between the TPMT*3C (rs1142345) Polymorphism and the Risk of Death in the Treatment of Acute Lymphoblastic Leukemia in Children from the Brazilian Amazon Region. Genes (Basel) 2020; 11:genes11101132. [PMID: 32992962 PMCID: PMC7601477 DOI: 10.3390/genes11101132] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 09/11/2020] [Accepted: 09/18/2020] [Indexed: 12/21/2022] Open
Abstract
Acute lymphoblastic leukemia (ALL) is the leading cause of death from pediatric cancer worldwide. However, marked ethnic disparities are found in the treatment of childhood ALL with less effective results and higher mortality rates being obtained in populations with a high level of Native American ancestry. Genetic variations of the patient can affect resistance to ALL chemotherapy and potentially play an important role in this disparity. In the present study, we investigated the association of 16 genetic polymorphisms with the cell and metabolic pathways of the chemotherapeutic agents used in the treatment of ALL with the risk of death in treating childhood ALL in patients with a high contribution of Amerindian ancestry, coming from the Brazilian Amazon. The study included 121 patients with B-cell ALL treated with the BFM-2002 protocol. We are the first to identify the association between the TPMT gene rs1142345 polymorphism and the high risk of death in treating childhood ALL. Patients with the CC genotype had an approximately 25.5 times higher risk of dying during treatment of the disease than patients with other genotypes (p = 0.019). These results may help elucidate how the patient's genetic characteristics contribute to the mortality disparity in populations with a high contribution of Native American ancestry. The rs1142345 variant of the TPMT gene could be used as a potential marker to early stratify patients at high risk of death in treating childhood ALL in the investigated population.
Collapse
Affiliation(s)
- Darlen Cardoso de Carvalho
- Oncology Research Nucleus, Universidade Federal do Pará, Belém 66063-023, Brazil; (D.C.d.C.); (L.P.C.L.); (F.A.R.M.J.); (A.V.W.); (R.B.A.d.S.); (A.C.-P.); (M.R.F.); (S.S.); (A.S.K.); (P.P.d.A.)
| | - Luciana Pereira Colares Leitão
- Oncology Research Nucleus, Universidade Federal do Pará, Belém 66063-023, Brazil; (D.C.d.C.); (L.P.C.L.); (F.A.R.M.J.); (A.V.W.); (R.B.A.d.S.); (A.C.-P.); (M.R.F.); (S.S.); (A.S.K.); (P.P.d.A.)
| | - Fernando Augusto Rodrigues Mello Junior
- Oncology Research Nucleus, Universidade Federal do Pará, Belém 66063-023, Brazil; (D.C.d.C.); (L.P.C.L.); (F.A.R.M.J.); (A.V.W.); (R.B.A.d.S.); (A.C.-P.); (M.R.F.); (S.S.); (A.S.K.); (P.P.d.A.)
| | - Alayde Vieira Wanderley
- Oncology Research Nucleus, Universidade Federal do Pará, Belém 66063-023, Brazil; (D.C.d.C.); (L.P.C.L.); (F.A.R.M.J.); (A.V.W.); (R.B.A.d.S.); (A.C.-P.); (M.R.F.); (S.S.); (A.S.K.); (P.P.d.A.)
- Departamento de Pediatria, Ophir Loyola Hospital, Belém 66063-240, Brazil
| | - Tatiane Piedade de Souza
- Human and Medical Genetics Laboratory, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém 66075-110, Brazil;
| | - Roberta Borges Andrade de Sá
- Oncology Research Nucleus, Universidade Federal do Pará, Belém 66063-023, Brazil; (D.C.d.C.); (L.P.C.L.); (F.A.R.M.J.); (A.V.W.); (R.B.A.d.S.); (A.C.-P.); (M.R.F.); (S.S.); (A.S.K.); (P.P.d.A.)
| | - Amanda Cohen-Paes
- Oncology Research Nucleus, Universidade Federal do Pará, Belém 66063-023, Brazil; (D.C.d.C.); (L.P.C.L.); (F.A.R.M.J.); (A.V.W.); (R.B.A.d.S.); (A.C.-P.); (M.R.F.); (S.S.); (A.S.K.); (P.P.d.A.)
| | - Marianne Rodrigues Fernandes
- Oncology Research Nucleus, Universidade Federal do Pará, Belém 66063-023, Brazil; (D.C.d.C.); (L.P.C.L.); (F.A.R.M.J.); (A.V.W.); (R.B.A.d.S.); (A.C.-P.); (M.R.F.); (S.S.); (A.S.K.); (P.P.d.A.)
| | - Sidney Santos
- Oncology Research Nucleus, Universidade Federal do Pará, Belém 66063-023, Brazil; (D.C.d.C.); (L.P.C.L.); (F.A.R.M.J.); (A.V.W.); (R.B.A.d.S.); (A.C.-P.); (M.R.F.); (S.S.); (A.S.K.); (P.P.d.A.)
- Human and Medical Genetics Laboratory, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém 66075-110, Brazil;
| | - André Salim Khayat
- Oncology Research Nucleus, Universidade Federal do Pará, Belém 66063-023, Brazil; (D.C.d.C.); (L.P.C.L.); (F.A.R.M.J.); (A.V.W.); (R.B.A.d.S.); (A.C.-P.); (M.R.F.); (S.S.); (A.S.K.); (P.P.d.A.)
| | - Paulo Pimentel de Assumpção
- Oncology Research Nucleus, Universidade Federal do Pará, Belém 66063-023, Brazil; (D.C.d.C.); (L.P.C.L.); (F.A.R.M.J.); (A.V.W.); (R.B.A.d.S.); (A.C.-P.); (M.R.F.); (S.S.); (A.S.K.); (P.P.d.A.)
- João de Barros Barreto University Hospital, Universidade Federal do Pará, Belém 66063-023, Brazil
| | - Ney Pereira Carneiro dos Santos
- Oncology Research Nucleus, Universidade Federal do Pará, Belém 66063-023, Brazil; (D.C.d.C.); (L.P.C.L.); (F.A.R.M.J.); (A.V.W.); (R.B.A.d.S.); (A.C.-P.); (M.R.F.); (S.S.); (A.S.K.); (P.P.d.A.)
- Human and Medical Genetics Laboratory, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém 66075-110, Brazil;
- Correspondence:
| |
Collapse
|
41
|
Shah N, Rockwell B, Kazemi M, Peeke S, Bachier-Rodriguez L, Sica RA, Goldfinger M, Kornblum N, Braunschweig I, Shastri A, Verma A, Mantzaris I. Ethnic disparities in survival of adult B-cell acute lymphoblastic leukemia in modern era – a SEER analysis. Leuk Lymphoma 2020; 61:3503-3506. [DOI: 10.1080/10428194.2020.1808211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Nishi Shah
- Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Bradley Rockwell
- Department of Internal Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Mohammad Kazemi
- Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Stephen Peeke
- Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Roberto Alejandro Sica
- Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mendel Goldfinger
- Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Noah Kornblum
- Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ira Braunschweig
- Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Aditi Shastri
- Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Amit Verma
- Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ioannis Mantzaris
- Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| |
Collapse
|
42
|
Clinical Characteristics and Treatment Results of Childhood Acute Lymphoblastic Leukemia in North Macedonia. ACTA ACUST UNITED AC 2020; 41:37-47. [PMID: 33011702 DOI: 10.2478/prilozi-2020-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Acute lymphoblastic leukemia (ALL) is the most common childhood cancer. This study was designed to determine the clinical, biological features and outcomes among children with ALL treated at the only pediatric hematology-oncology center in North Macedonia. PATIENTS AND METHODS Seventy four consecutive children age 1 to 14 years, diagnosed with ALL between January 1, 2010 and October 31, 2017 and treated according to ALL IC BFM 2002 protocol were retrospectively evaluated. RESULTS The median age at diagnosis was 5 years and males were predominant (60.8%). Precursor B-cell ALL was diagnosed in 81.1% of patients, while 18.9% had T cell ALL. CNS involvement at the time of diagnoses was present in 6.8% of patients. Complete remission was achieved in 93.2% of patients. The induction death rate was 5.4%. The rate of death during first complete remission was 4.1%. Relapse occurred in 13.5% of patients. After a median observation time of 44 months, the 5-year overall survival (OS) and event-free survival (EFS) rates (± standard error) were 79.4% ± 5.2% and 74% ± 5.7%, respectively. The 5-year EFS rate for patients categorized as standard risk by NCI criteria was significantly higher than for high risk patients (83.3% versus 46.7%; P<0.001). Patients with precursor B-cell ALL and negative minimal residual disease (MRD) status at the end of induction had the best prognoses. CONCLUSION Our study demonstrated that the treatment results of childhood ALL in North Macedonia are comparable to those obtained in the ALL IC BFM 2002 trial.
Collapse
|
43
|
Lancaster BD, Van Allen J. JPP Student Journal Club Commentary: Future Considerations for Sleep Research With Cancer Survivors and Their Siblings. J Pediatr Psychol 2020; 45:717-719. [PMID: 32653915 DOI: 10.1093/jpepsy/jsaa054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 06/23/2020] [Accepted: 06/23/2020] [Indexed: 11/12/2022] Open
|
44
|
Krakora R, Shih W, Popli P, Gorshein E, Salaru G, Moore D, Chen C, David K, Bannerji R. Impact of Insurance Status on Survival Outcomes in Adults With Acute Lymphoblastic Leukemia (ALL): A Single-center Experience. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:e890-e896. [PMID: 32773302 DOI: 10.1016/j.clml.2020.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/12/2020] [Accepted: 06/18/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Socioeconomic factors including race, ethnicity, and poverty level have been associated with disparities in survival among adult patients with acute leukemia. Insurance status is also likely to affect survival outcomes in these patients but has not been well studied. We investigated the impact of insurance status at time of diagnosis on survival in adult patients with acute lymphoblastic leukemia (ALL). PATIENTS AND METHODS Adult patients diagnosed with B-lineage ALL between January 1, 2007 and October 31, 2017 were included, with follow-up through January 19, 2018. Kaplan-Meier survival curves were used to estimate overall survival (OS) and progression-free survival (PFS) for the 2 groups. Cox proportional hazard regression methods were used for univariate and multivariate analyses. RESULTS A total of 136 patients were included in the study, 29 without insurance and 107 with insurance at time of diagnosis. Patients without insurance were younger and more likely to be Hispanic or Latino compared with insured patients. When controlling for confounding variables, patients without insurance had worse PFS. There was no statistically significant difference in OS between the 2 groups. Hispanic or Latino ethnicity was associated with improved PFS and OS in multivariate analyses. CONCLUSIONS Adult patients with ALL without health insurance at time of diagnosis had worse PFS when controlling for other relevant clinical factors. Lack of insurance may be an obstacle to timely, effective maintenance therapy in the outpatient setting. Further research is needed to understand how insurance status impacts survival and ways to mitigate any disparities.
Collapse
Affiliation(s)
- Rebecca Krakora
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Weichung Shih
- Department of Biostatistics, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Pallvi Popli
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Elan Gorshein
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Gratian Salaru
- Department of Pathology and Laboratory Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Dirk Moore
- Department of Biostatistics, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Chunxia Chen
- Department of Biostatistics, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Kevin David
- Division of Blood Disorders, Section of Hematologic Malignancies, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Rajat Bannerji
- Division of Blood Disorders, Section of Hematologic Malignancies, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.
| |
Collapse
|
45
|
Shoag JM, Barredo JC, Lossos IS, Pinheiro PS. Acute lymphoblastic leukemia mortality in Hispanic Americans. Leuk Lymphoma 2020; 61:2674-2681. [DOI: 10.1080/10428194.2020.1779260] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Jamie M. Shoag
- Department of Pediatric, Hematology and Oncology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Julio C. Barredo
- Department of Pediatric, Hematology and Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Izidore S. Lossos
- Department of Medicine, Hematology and Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Paulo S. Pinheiro
- Department of Public Health Sciences, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
46
|
Dong Y, Shi O, Zeng Q, Lu X, Wang W, Li Y, Wang Q. Leukemia incidence trends at the global, regional, and national level between 1990 and 2017. Exp Hematol Oncol 2020; 9:14. [PMID: 32577323 PMCID: PMC7304189 DOI: 10.1186/s40164-020-00170-6] [Citation(s) in RCA: 114] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/15/2020] [Indexed: 12/11/2022] Open
Abstract
Background Leukemias are a group of life-threatening malignant disorders of the blood and bone marrow. The incidence of leukemia varies by pathological types and among different populations. Methods We retrieved the incidence data for leukemia by sex, age, location, calendar year, and type from the Global Burden of Disease online database. The estimated average percentage change (EAPC) was used to quantify the trends of the age-standardized incidence rate (ASIR) of leukemia from 1990 to 2017. Results Globally, while the number of newly diagnosed leukemia cases increased from 354.5 thousand in 1990 to 518.5 thousand in 2017, the ASIR decreased by 0.43% per year. The number of acute lymphoblastic leukemia (ALL) cases worldwide increased from 49.1 thousand in 1990 to 64.2 thousand in 2017, whereas the ASIR experienced a decrease (EAPC = - 0.08, 95% CI - 0.15, - 0.02). Between 1990 and 2017, there were 55, 29, and 111 countries or territories that experienced a significant increase, remained stable, and experienced a significant decrease in ASIR of ALL, respectively. The case of chronic lymphocytic leukemia (CLL) has increased more than twice between 1990 and 2017. The ASIR of CLL increased by 0.46% per year from 1990 to 2017. More than 85% of all countries saw an increase in ASIR of CLL. In 1990, acute myeloid leukemia (AML) accounted for 18.0% of the total leukemia cases worldwide. This proportion increased to 23.1% in 2017. The ASIR of AML increased from 1.35/100,000 to 1.54/100,000, with an EAPC of 0.56 (95% CI 0.49, 0.62). A total of 127 countries or territories experienced a significant increase in the ASIR of AML. The number of chronic myeloid leukemia (CML) cases increased from 31.8 thousand in 1990 to 34.2 thousand in 2017. The ASIR of CML decreased from 0.75/100,000 to 0.43/100,000. A total of 141 countries or territories saw a decrease in ASIR of CML. Conclusions A significant decrease in leukemia incidence was observed between 1990 and 2017. However, in the same period, the incidence rates of AML and CLL significantly increased in most countries, suggesting that both types of leukemia might become a major global public health concern.
Collapse
Affiliation(s)
- Ying Dong
- Department of Hematology, Maoming People's Hospital, Maoming, Guangdong 525000 China
| | - Oumin Shi
- Health Science Center, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, 518020 China
| | - Quanxiang Zeng
- Digestion Department of Digestion, Maoming People's Hospital, Maoming, Guangdong 525000 China
| | - Xiaoqin Lu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450014 China
| | - Wei Wang
- School of Public Health, Zhengzhou University, Zhengzhou, Henan 450014 China
| | - Yong Li
- Department of Oncology, Guizhou Provincial People's Hospital, Guiyang, Guizhou 550002 China
| | - Qi Wang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450014 China.,School of Public Health, Zhengzhou University, Zhengzhou, Henan 450014 China.,China-Canada Medical and Healthcare Science Association, Toronto, ON L3R 1A3 Canada
| |
Collapse
|
47
|
Alvarez EM, Malogolowkin M, Hoch JS, Li Q, Brunson A, Pollock BH, Muffly L, Wun T, Keegan THM. Treatment Complications and Survival Among Children and Young Adults With Acute Lymphoblastic Leukemia. JCO Oncol Pract 2020; 16:e1120-e1133. [PMID: 32525752 DOI: 10.1200/jop.19.00572] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE We previously demonstrated lower early mortality for young adults (YAs) with acute lymphoblastic leukemia (ALL) who received induction treatment at specialized cancer centers (SCCs) versus community hospitals. The aim of this study is to determine the impact of inpatient location of treatment throughout therapy on long-term survival, complications, and cost-associations that have not yet been evaluated at the population level. METHODS Using the California Cancer Registry linked to a hospitalization database, we identified patients, 0-39 years of age, diagnosed with first primary ALL who received inpatient treatment between 1991 and 2014. Patients were classified as receiving all or part or none of their inpatient treatment at an SCC within 3 years of diagnosis. Inverse probability-weighted, multivariable Cox regression models estimated the associations between location of treatment and sociodemographic and clinical factors with survival. We compared 3-year inpatient costs overall and per day by age group and location of care. RESULTS Eighty-four percent (0-18 years; n = 4,549) of children and 36% of YAs (19-39 years; n = 683) received all treatment at SCCs. Receiving all treatment at an SCC was associated with superior leukemia-specific (hazard ratio [HR], 0.76; 95% CI, 0.67 to 0.88) and overall survival (HR, 0.87; 95% CI, 0.77 to 0.97) in children and in YAs (HR, 0.71; 95% CI, 0.61 to 0.83; HR, 0.70; 95% CI, 0.62 to 0.80) even after controlling for complications. The cost of inpatient care during the full course of therapy was higher in patients receiving all of their care at SCCs. CONCLUSION Our results demonstrate that inpatient treatment at an SCC throughout therapy is associated with superior survival; therefore, strong consideration should be given to referring these patients to SCCs.
Collapse
Affiliation(s)
- Elysia M Alvarez
- Division of Pediatric Hematology and Oncology, University of California Davis School of Medicine, Sacramento, CA
| | - Marcio Malogolowkin
- Division of Pediatric Hematology and Oncology, University of California Davis School of Medicine, Sacramento, CA
| | - Jeffrey S Hoch
- Division of Health Policy and Management, Department of Public Health Sciences, University of California Davis School of Medicine, Sacramento, CA
| | - Qian Li
- Center for Oncology Hematology Outcomes Research and Training and Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, CA
| | - Ann Brunson
- Center for Oncology Hematology Outcomes Research and Training and Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, CA
| | - Brad H Pollock
- Division of Health Policy and Management, Department of Public Health Sciences, University of California Davis School of Medicine, Sacramento, CA
| | - Lori Muffly
- Division of Bone Marrow and Transplantation, Stanford University, Stanford, CA
| | - Ted Wun
- Center for Oncology Hematology Outcomes Research and Training and Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, CA.,University of California Davis Clinical and Translational Science Center, Sacramento, CA
| | - Theresa H M Keegan
- Division of Health Policy and Management, Department of Public Health Sciences, University of California Davis School of Medicine, Sacramento, CA.,Center for Oncology Hematology Outcomes Research and Training and Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, CA
| |
Collapse
|
48
|
Lupo PJ, Spector LG. Cancer Progress and Priorities: Childhood Cancer. Cancer Epidemiol Biomarkers Prev 2020; 29:1081-1094. [DOI: 10.1158/1055-9965.epi-19-0941] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 12/18/2019] [Accepted: 03/09/2020] [Indexed: 11/16/2022] Open
|
49
|
Kyrönlahti A, Madanat-Harjuoja L, Pitkäniemi J, Rantanen M, Malila N, Taskinen M. Childhood cancer mortality and survival in immigrants: A population-based registry study in Finland. Int J Cancer 2020; 146:2746-2755. [PMID: 31407318 DOI: 10.1002/ijc.32625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 07/06/2019] [Accepted: 07/09/2019] [Indexed: 12/30/2022]
Abstract
Immigration in Europe has increased considerably over the past decades with the immigrant population similarly expanding in Finland. Our aim was to study childhood cancer mortality and survival in immigrants. In all, 4,437 patients diagnosed with cancer under the age of 20 years between 1990 and 2009 were identified from the Finnish Cancer Registry and their parents from the Population Register Center. Information on demographic factors was obtained from Statistics Finland. Poisson regression modeling was used to estimate hazard ratios (HRs) for cancer deaths. The life table method and the log rank test were used in survival analysis. Patients or parents of foreign background and born abroad had higher 5-year mortality (patient HR 2.03, 95% CI 1.18-3.49; maternal HR 2.11, 95% CI 1.46-3.04; paternal HR 1.85, 95% CI 1.29-2.66) compared to those of Finnish background and born in Finland. Childhood cancer survival in 5-year follow-up was higher if the mother (83% vs. 68%) or the father (83% vs. 70%) were of Finnish background and born in Finland. Despite equal access to public health care, we observed significant differences in childhood cancer mortality and survival by background. Cultural differences, linguistic obstacles and difficulties in navigating the health care system may contribute, along with genetic and biologic factors. Offering tailored information and taking cultural and linguistic aspects into account is necessary when diagnosing and treating patients from different ethnic backgrounds who have not yet integrated into the local culture and health care system.
Collapse
Affiliation(s)
- Anniina Kyrönlahti
- Finnish Cancer Registry, Helsinki, Finland.,New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Laura Madanat-Harjuoja
- Finnish Cancer Registry, Helsinki, Finland.,New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Janne Pitkäniemi
- Finnish Cancer Registry, Helsinki, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland
| | | | - Nea Malila
- Finnish Cancer Registry, Helsinki, Finland
| | - Mervi Taskinen
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
50
|
The Relationship between Health Disparities, Psychosocial Functioning and Health Outcomes in Pediatric Hematology-Oncology and Stem Cell Transplant Populations: Recommendations for Clinical Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072218. [PMID: 32224963 PMCID: PMC7178256 DOI: 10.3390/ijerph17072218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/20/2020] [Accepted: 03/22/2020] [Indexed: 01/09/2023]
Abstract
Not only do racial and ethnic minority children and adolescents with chronic illness experience disparities in health status and health outcomes, they also experience significant healthcare disparities, including differences in healthcare coverage, access to care, and quality of care. It is well known that the interaction between psychosocial functioning, health behaviors and ethnic and racial disparities, ultimately leads to worse health and psychosocial outcomes in pediatric and AYA chronic illness patient populations, including increased rates of morbidity and mortality. Investigating the impact of racial and ethnic factors on health outcomes, and strategies for reducing these disparities, is of the utmost importance, specifically in life-threatening conditions like cancer and sickle cell disease. This commentary underscores the relative importance of identifying factors that could reduce disparities between minority and non-minority populations. This present paper will focus on the dynamic relationships between health disparities, psychosocial factors and health outcomes within pediatric cancer, sickle cell disease and bone marrow transplant populations, and will offer recommendations for healthcare professionals working with these vulnerable patient populations. The primary goal of this commentary is to provide recommendations for enhancing cultural competency and humility for those working with highly vulnerable patient populations.
Collapse
|