1
|
Shen D, Liu L, Xu X, Song H, Zhang J, Xu W, Zhao F, Liang J, Liao C, Wang Y, Xia T, Wang C, Lou F, Cao S, Qin J, Tang Y. Spectrum and clinical features of gene mutations in Chinese pediatric acute lymphoblastic leukemia. BMC Pediatr 2023; 23:62. [PMID: 36739388 PMCID: PMC9898934 DOI: 10.1186/s12887-023-03856-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 01/19/2023] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The 5-year survival rate of children with acute lymphoblastic leukemia (ALL) is 85-90%, with a 10-15% rate of treatment failure. Next-generation sequencing (NGS) identified recurrent mutated genes in ALL that might alter the diagnosis, classification, prognostic stratification, treatment, and response to ALL. Few studies on gene mutations in Chinese pediatric ALL have been identified. Thus, an in-depth understanding of the biological characteristics of these patients is essential. The present study aimed to characterize the spectrum and clinical features of recurrent driver gene mutations in a single-center cohort of Chinese pediatric ALL. METHODS We enrolled 219 patients with pediatric ALL in our single center. Targeted sequencing based on NGS was used to detect gene mutations in patients. The correlation was analyzed between gene mutation and clinical features, including patient characteristics, cytogenetics, genetic subtypes, risk stratification and treatment outcomes using χ2-square test or Fisher's exact test for categorical variables. RESULTS A total of 381 gene mutations were identified in 66 different genes in 152/219 patients. PIK3R1 mutation was more common in infants (P = 0.021). KRAS and FLT3 mutations were both more enriched in patients with hyperdiploidy (both P < 0.001). NRAS, PTPN11, FLT3, and KMT2D mutations were more common in patients who did not carry the fusion genes (all P < 0.050). PTEN mutation was significantly associated with high-risk ALL patients (P = 0.011), while NOTCH1 mutation was common in middle-risk ALL patients (P = 0.039). Patients with ETV6 or PHF6 mutations were less sensitive to steroid treatment (P = 0.033, P = 0.048, respectively). CONCLUSION This study depicted the specific genomic landscape of Chinese pediatric ALL and revealed the relevance between mutational spectrum and clinical features of Chinese pediatric ALL, which highlights the need for molecular classification, risk stratification, and prognosis evaluation.
Collapse
Affiliation(s)
- Diying Shen
- grid.13402.340000 0004 1759 700XPediatric Hematology-Oncology Center, Zhejiang Provincial Center for Childhood Leukemia Diagnosis and Treatment, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Lixia Liu
- Acornmed Biotechnology Co., Ltd, Tianjin, China
| | - Xiaojun Xu
- grid.13402.340000 0004 1759 700XPediatric Hematology-Oncology Center, Zhejiang Provincial Center for Childhood Leukemia Diagnosis and Treatment, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Hua Song
- grid.13402.340000 0004 1759 700XPediatric Hematology-Oncology Center, Zhejiang Provincial Center for Childhood Leukemia Diagnosis and Treatment, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jingying Zhang
- grid.13402.340000 0004 1759 700XPediatric Hematology-Oncology Center, Zhejiang Provincial Center for Childhood Leukemia Diagnosis and Treatment, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Weiqun Xu
- grid.13402.340000 0004 1759 700XPediatric Hematology-Oncology Center, Zhejiang Provincial Center for Childhood Leukemia Diagnosis and Treatment, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Fenying Zhao
- grid.13402.340000 0004 1759 700XPediatric Hematology-Oncology Center, Zhejiang Provincial Center for Childhood Leukemia Diagnosis and Treatment, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Juan Liang
- grid.13402.340000 0004 1759 700XPediatric Hematology-Oncology Center, Zhejiang Provincial Center for Childhood Leukemia Diagnosis and Treatment, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Chan Liao
- grid.13402.340000 0004 1759 700XPediatric Hematology-Oncology Center, Zhejiang Provincial Center for Childhood Leukemia Diagnosis and Treatment, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Yan Wang
- grid.13402.340000 0004 1759 700XPediatric Hematology-Oncology Center, Zhejiang Provincial Center for Childhood Leukemia Diagnosis and Treatment, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Tian Xia
- grid.13402.340000 0004 1759 700XPediatric Hematology-Oncology Center, Zhejiang Provincial Center for Childhood Leukemia Diagnosis and Treatment, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | | | - Feng Lou
- Acornmed Biotechnology Co., Ltd, Tianjin, China
| | - Shanbo Cao
- Acornmed Biotechnology Co., Ltd, Tianjin, China
| | - Jiayue Qin
- Acornmed Biotechnology Co., Ltd, Tianjin, China
| | - Yongmin Tang
- Pediatric Hematology-Oncology Center, Zhejiang Provincial Center for Childhood Leukemia Diagnosis and Treatment, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
| |
Collapse
|
2
|
Son M, Kim HR, Choe SA, Ki M, Yong F, Park M, Paek D. Widening Social Inequalities in Cancer Mortality of Children Under 5 Years in Korea. J Korean Med Sci 2023; 38:e20. [PMID: 36625176 PMCID: PMC9829512 DOI: 10.3346/jkms.2023.38.e20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 10/12/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND To investigate the effect of parental social class on cancer mortality in children under 5 in Korea, two birth cohorts were constructed by linking national birth data to under-5 death data from the Statistics Korea for 1995-1999 (3,323,613 births) and 2010-2014 (2,297,876 births). METHODS The Cox proportional hazards model adjusted for covariates was used in this study. RESULTS Social inequalities of under-5 cancer mortality risk in paternal education and paternal employment status were greater in 2010-2014 than in 1995-1999. The gap of hazard ratio (HR) of under-5 cancer mortality between lower (high school or below) and higher (university or higher) paternal education increased from 1.23 (95% confidence interval, 1.041.46) in 1995-1999 to 1.45 (1.11-1.97) in 2010-2014; the gap of HR between parents engaged in manual work and non-manual work increased from 1.32 (1.12-1.56) in 1995-1999 to 1.45 (1.12-1.89) in 2010-2014 for fathers, and from 1.18 (0.7-1.98) to 1.69 (1.03-2.79) for mothers. When the parental social class was lower, the risk of under-5 cancer mortality was higher in not only adverse but normal births. CONCLUSION Social inequalities must be addressed to reduce the disparity in cancer mortality of children under 5 years old.
Collapse
Affiliation(s)
- Mia Son
- Department of Preventive Medicine, College of Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Hye Ri Kim
- Department of Preventive Medicine, College of Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Seung-Ah Choe
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea
- Division of Life Science, Korea University, Seoul, Korea
| | - Myung Ki
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea
- BK21FOUR R&E Center for Learning Health Systems, Korea University, Seoul, Korea
| | - Fran Yong
- Department of Preventive Medicine, College of Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Mijin Park
- Wonjin Institute for Occupational & Environmental Health, Seoul, Korea
- Institute of Health and Environment, Seoul National University, Seoul, Korea
| | - Domyung Paek
- Wonjin Institute for Occupational & Environmental Health, Seoul, Korea
- National Cancer Center, Goyang, Korea
- Graduate School of Public Health, Seoul National University, Seoul, Korea.
| |
Collapse
|
3
|
He X, Yao P, Li M, Liang H, Liu Y, Du S, Zhang M, Sun W, Wang Z, Hao X, Yu Z, Gao F, Liu X, Tong R. A Risk Scoring Model for High-Dose Methotrexate-Induced Liver Injury in Children With Acute Lymphoblastic Leukemia Based on Gene Polymorphism Study. Front Pharmacol 2021; 12:726229. [PMID: 34658865 PMCID: PMC8511303 DOI: 10.3389/fphar.2021.726229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
A study on 70 acute lymphoblastic leukemia (ALL) children (age ≤16 years) treated with high-dose methotrexate (HD-MTX) in Sichuan Provincial People’s Hospital was conducted. The aim of the study was to establish a risk-scoring model to predict HD-MTX-induced liver injury, considering gene polymorphisms’ effects. Data screening was performed through t-test, chi-square test, and ridge regression, and six predictors were identified: age, MTRR_AA, MTRR_AG, SLCO1B1_11045879_CC, albumin_1 day before MTX administration, and IBIL_1 day before MTX administration (p < 0.1). Then, the risk-scoring model was established by ridge regression and evaluated the prediction performance. In a training cohort (n = 49), the area under the curve (AUC) was 0.76, and metrics including accuracy, precision, sensitivity, specificity, positive predictive value, and negative predictive value were promising (0.86, 0.81, 0.76, 0.91, 0.81, 0.88, respectively). In a test cohort (n = 21), the AUC was 0.62 and negative predictive value was 0.80; other evaluation metrics were not satisfactory, possibly due to the limited sample size. Ultimately, the risk scores were stratified into three groups based on their distributions: low- (≤48), medium- (49–89), and high-risk (>89) groups. This study could provide knowledge for the prediction of HD-MTX-induced liver injury and reference for the clinical medication.
Collapse
Affiliation(s)
- Xia He
- Department of Pharmacy, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China.,Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | | | - Mengting Li
- Department of Pharmacy, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China.,Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Hong Liang
- Department of Pharmacy, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China.,Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yilong Liu
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Shan Du
- Department of Pharmacy, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China.,Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Min Zhang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wenzhuo Sun
- Xi'an Jiaotong-liverpool University, Xi'an, China
| | - Zeyuan Wang
- Beijing Medicinovo Technology Co. Ltd., Beijing, China
| | - Xin Hao
- Dalian Medicinovo Technology Co. Ltd., Dalian, China
| | - Ze Yu
- Beijing Medicinovo Technology Co. Ltd., Beijing, China
| | - Fei Gao
- Beijing Medicinovo Technology Co. Ltd., Beijing, China
| | - Xinxia Liu
- Department of Pharmacy, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China.,Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Rongsheng Tong
- Department of Pharmacy, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China.,Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| |
Collapse
|
4
|
Chen SL, Zhang H, Gale RP, Tang JY, Pui CH, Chen SJ, Liang Y. Toward the Cure of Acute Lymphoblastic Leukemia in Children in China. JCO Glob Oncol 2021; 7:1176-1186. [PMID: 34292767 PMCID: PMC8457838 DOI: 10.1200/go.21.00049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This study explored results of therapy of children with acute lymphoblastic leukemia (ALL) in China, recent progress, and challenges. Included are a survey of therapy outcomes of ALL in Chinese children nationwide, comparison of these data with global ALL therapy outcomes, analyses of obstacles to improving outcomes, and suggestions of how progress can be achieved. Therapy outcomes at many Chinese pediatric cancer centers are approaching those of resource-rich countries. However, nationwide outcomes still need improvement. Obstacles include suboptimal clinical trials participation, children without adequate health care funding, human resource shortages, especially physicians expert in pediatric hematology and oncology, and social-economic disparities. We suggest how these obstacles have been and continue to be remedied including expanded access to protocol-based therapy, improved supportive care, health care reforms, recruitment of trained personnel, and international collaborations. China has made substantial progress treating children with ALL. We envision even better outcomes in the near future.
Collapse
Affiliation(s)
- Si-Liang Chen
- Department of Hematologic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Hui Zhang
- Department of Hematology and Oncology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
| | - Robert Peter Gale
- Department of Immunology and Inflammation, Haematology Research Centre, Imperial College London, London, United Kingdom
| | - Jing-Yan Tang
- Key Laboratory of Pediatric Hematology and Oncology Ministry of Health, Department of Hematology and Oncology, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ching-Hon Pui
- Departments of Oncology, Global Pediatric Medicine, and Pathology, St Jude Children's Research Hospital, Memphis, TN
| | - Sai-Juan Chen
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yang Liang
- Department of Hematologic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| |
Collapse
|
5
|
Zhang P, Zhang Y, Li X, Ying P, Tang Y. U2AF1 expression is a novel and independent prognostic indicator of childhood T-lineage acute lymphoblastic leukemia. Int J Lab Hematol 2020; 43:675-682. [PMID: 33314767 DOI: 10.1111/ijlh.13433] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/20/2020] [Accepted: 11/24/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION U2AF1 gene is associated with various types of hematological malignancies in adults. However, the expression level of U2AF1 gene and its prognostic significance are unclear in pediatric ALL patients. The study aimed to study the mRNA level of U2AF1 in pediatric ALL patients and its clinical relevance with long-term survival. METHODS We quantitatively determined U2AF1 gene expression at diagnosis in 132 children with ALL by real-time PCR. According to the patients' median U2AF1 value, the patients' samples were classified into low U2AF1 and high U2AF1 expression groups. Twenty-two bone marrow samples from 22 patients with ITP were recruited as control. The correlation between the expression level of U2AF1 and clinical treatment outcome was analyzed. RESULTS Pediatric patients with ALL showed higher U2AF1 mRNA levels than controls (P = .034). The relapse rates of patients in low U2AF1 levels group were obviously higher than those of U2AF1 high expression group (28.8% vs 12.1%, P = .030). Patients of low U2AF1 expression presented worse 5-year EFS than those of high U2AF1 expression (60% vs 81%, P = .035). For T-ALL, patients with low U2AF1 mRNA level showed lower BM blast percentages (P = .031), worse EFS (37.8% vs 92.3%, P = .003), and CIR (62.2% vs 7.7%, P = .003) than those in high U2AF1 expression group. Multivariate analysis confirmed low U2AF1 mRNA level could be used as an independent risk indicator of poor EFS and CIR of children with T-ALL. CONCLUSION Low U2AF1 mRNA level is related to inferior prognosis and can be served as a prognostic indicator for risk stratification in children with T-ALL.
Collapse
Affiliation(s)
- Ping Zhang
- Department of Hematology-Oncology, Pediatric Hematology-Oncology Center, Zhejiang Provincial Pediatric Leukemia Diagnostic and Therapeutic Research Center, Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Yao Zhang
- Department of Hematology-Oncology, Pediatric Hematology-Oncology Center, Zhejiang Provincial Pediatric Leukemia Diagnostic and Therapeutic Research Center, Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.,Children's Hospital of Shanxi Province, Taiyuan, China
| | - Xiaoxiao Li
- Department of Hematology-Oncology, Pediatric Hematology-Oncology Center, Zhejiang Provincial Pediatric Leukemia Diagnostic and Therapeutic Research Center, Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Peiting Ying
- Department of Hematology-Oncology, Pediatric Hematology-Oncology Center, Zhejiang Provincial Pediatric Leukemia Diagnostic and Therapeutic Research Center, Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Yongmin Tang
- Department of Hematology-Oncology, Pediatric Hematology-Oncology Center, Zhejiang Provincial Pediatric Leukemia Diagnostic and Therapeutic Research Center, Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| |
Collapse
|
6
|
Lashkari HP, Faheem M, Sridevi Hanaganahalli B, Bhat KG, Joshi J, Kamath N, Ahlawat S, B P. Resource limited centres can deliver treatment for children with acute lymphoblastic leukaemia with risk-stratified minimal residual disease based UKALL 2003 protocol with no modification and a good outcome. Expert Rev Hematol 2020; 13:1143-1151. [PMID: 32870048 DOI: 10.1080/17474086.2020.1813563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Acute Lymphoblastic Leukemia (ALL) is the most common malignancy in children. With improved supportive care and a better understanding of the disease biology, it is now a curable cancer in the developed world. However, in low-income countries, the cure rate remains relatively poor. We report our experience on the survival of children with ALL treated on the MRD-based risk-stratified UKALL 2003 protocol, from a center in South India. METHODS All consecutive children diagnosed with ALL between years 2013 and 2019 were included in this retrospective study. All received uniform treatment as per the UKALL 2003 protocol based on NCI risk and post-induction MRD status. All the details including the type of leukemia, NCI risk status, date of diagnosis, treatment start date, the regimen, MRD status, cytogenetics, molecular genetics, and complications were captured. Analysis was done using prism GraphPad version 8.0. RESULTS A total of 107 children were started on treatment during this period. The majority of them were boys (68/107). Fifty-nine of them were NCI standard risk (55%). B-ALL was the most common type (92%).Total of 56/107(52.3%) children received treatment under the government's insurance scheme for low-income bracket. The post-induction MRD was performed in 95/107 children. It was >0.01% in 22% (21/95) of children. Five (4.7%) children relapsed so far with a mean follow up of 27 months from the diagnosis. There were 17 deaths (15.9%). The EFS at 3 years was 85% (95% CI 75% to 92%). CONCLUSION It is feasible to deliver chemotherapy as per the UKALL2003 protocol without any modifications in resource-limited setting. The survival rates have significantly improved over the years in our center from 5 years EFS of 60% in 2010 and now to 3 year EFS of 85%. It is important to note that there was no treatment abandonment in our cohort.
Collapse
Affiliation(s)
- Harsha Prasada Lashkari
- Department of Paediatrics, Kasturba Medical College , Mangalore, India.,Department of Paediatrics, Manipal Academy of Higher Education , Manipal, India
| | - Moideen Faheem
- Department of Paediatrics, Kasturba Medical College , Mangalore, India.,Department of Paediatrics, Manipal Academy of Higher Education , Manipal, India
| | - Basaviah Sridevi Hanaganahalli
- Department of Paediatrics, Kasturba Medical College , Mangalore, India.,Department of Paediatrics, Manipal Academy of Higher Education , Manipal, India
| | - Kamalakshi G Bhat
- Department of Paediatrics, Kasturba Medical College , Mangalore, India.,Department of Paediatrics, Manipal Academy of Higher Education , Manipal, India
| | - Jayatheerth Joshi
- Department of Paediatrics, Kasturba Medical College , Mangalore, India.,Department of Paediatrics, Manipal Academy of Higher Education , Manipal, India
| | - Nutan Kamath
- Department of Paediatrics, Kasturba Medical College , Mangalore, India.,Department of Paediatrics, Manipal Academy of Higher Education , Manipal, India
| | - Shivali Ahlawat
- Department of Paediatrics, Oncquest Laboratories , New Delhi, India
| | - Prashantha B
- Department of Paediatrics, Kasturba Medical College , Mangalore, India.,Department of Paediatrics, Manipal Academy of Higher Education , Manipal, India
| |
Collapse
|
7
|
Childhood cancer mortality trends in Europe, 1990-2017, with focus on geographic differences. Cancer Epidemiol 2020; 67:101768. [DOI: 10.1016/j.canep.2020.101768] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/28/2020] [Accepted: 06/13/2020] [Indexed: 12/15/2022]
|
8
|
Liu K, Chu J, Dai Y, Jiang A, Yang L, Xie Z, Zhang K, Tu S, Cai H, Wu Z, Wang N. Long-term follow-up of acute lymphoblastic leukemia in young children treated by the SCMC-ALL-2009 protocol. Leuk Lymphoma 2020; 61:2850-2858. [PMID: 32643496 DOI: 10.1080/10428194.2020.1786557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This study evaluated the long-term therapeutic effect and prognostic factors of acute lymphoblastic leukemia (ALL) in 100 young Chinese children (<2 years old) who were enrolled in the Shanghai Children's Medical Center (SCMC)-ALL-2009 study in five pediatric hematological disease centers based on collaboration. The 5-year and 10-year event-free survivals (EFS) were 74.7 ± 3.2% and 73.3 ± 3.4%. The 10-year EFS rates for low risk, intermediate-risk, and high-risk patients were 81.9 ± 5.0%, 71.3 ± 4.3%, and 22.2 ± 13.9%, respectively. Relapse occurred in 19 patients. MRD results on day 55, good or poor response to prednisolone, and age at diagnosis were shown to have important prognostic and therapeutic implications. Compared with the SCMC-ALL-2005 protocol, showed that the 10-year-EFS and 10-year-overall survival of the SCMC-ALL-2009 protocol were better than that of the -2005 protocol. Notably, the intermediate-risk group was improved after the chemotherapy intensity was strengthened.
Collapse
Affiliation(s)
- Kangkang Liu
- Department of Pediatrics, The Second Hospital of Anhui Medical University, Hefei, China
| | - Jinhua Chu
- Department of Pediatrics, The Second Hospital of Anhui Medical University, Hefei, China
| | - Yu Dai
- Department of Pediatrics, The Second Hospital of Anhui Medical University, Hefei, China.,Department of Pediatrics, The Fourth Hospital of Anhui Medical University, Hefei, China
| | - Aoshuang Jiang
- Department of Pediatrics, The Second Hospital of Anhui Medical University, Hefei, China.,Hematology Department, Anhui Provincial Children's Hospital, Hefei, China
| | - Linhai Yang
- Department of Pediatrics, The Second Hospital of Anhui Medical University, Hefei, China
| | - Zhiwei Xie
- Department of Pediatrics, The Second Hospital of Anhui Medical University, Hefei, China
| | - Kunlong Zhang
- Department of Pediatrics, The Second Hospital of Anhui Medical University, Hefei, China
| | - Songji Tu
- Department of Pediatrics, The Second Hospital of Anhui Medical University, Hefei, China
| | - Huaju Cai
- Department of Pediatrics, The Second Hospital of Anhui Medical University, Hefei, China
| | - Zhengyu Wu
- Department of Pediatrics, The Second Hospital of Anhui Medical University, Hefei, China
| | - Ningling Wang
- Department of Pediatrics, The Second Hospital of Anhui Medical University, Hefei, China
| |
Collapse
|
9
|
Rs4846049 Polymorphism at the 3'-UTR of MTHFR Gene: Association with Susceptibility to Childhood Acute Lymphoblastic Leukemia. BIOMED RESEARCH INTERNATIONAL 2019; 2019:4631091. [PMID: 31737664 PMCID: PMC6815600 DOI: 10.1155/2019/4631091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/20/2019] [Accepted: 07/11/2019] [Indexed: 11/25/2022]
Abstract
Background Accumulating evidence has suggested the polymorphisms of methylenetetrahydrofolate reductase (MTHFR) were associated with susceptibility to childhood acute lymphoblastic leukemia (ALL). However, the known conclusions of currently known polymorphic loci (677 C > T and 1298 A > C) remain controversial. This study was to investigate new genetic biomarkers for ALL by analyzing the MTHFR polymorphisms at the 3′-untranslated region, which is a location bound by miRNAs. Methods Polymorphisms of rs4846049 (miR-555 binding) were assessed by PCR amplification and direct sequencing in 110 ALL patients and 105 healthy controls. The relative expression of MTHFR was detected by qRT-PCR. Results Overall, genotype distribution or allele carrier frequencies were not significantly different between patients with ALL and healthy controls (P > 0.05). Subgroup analysis results showed that T allele (OR = 0.134, 95% CI = 0.028–0.639; P=0.005) or genotypes with T allele (TT + GT) (OR = 0.133, 95% CI: 0.024–0.727; P=0.017) may be a protective factor for ALL susceptibility in patients with age >8 years. This conclusion was also true for the group only focusing on the precursor B-cell ALL patients. Furthermore, karyotype abnormality was more commonly observed in patients with the GG genotype (56.0%) compared to carriers of TT (0%) or GT (40.6%) genotypes, while c-myc break frequency was significantly higher in TT carriers (33%) than that of patients with GT (3.1%) or GG (0%) genotypes. PCR analysis showed patients carrying the GG genotype of rs4846049 exhibited the reduced mRNA expression of MTHFR. Conclusion MTHFR rs4846049 polymorphism may be associated with increased risk of childhood with ALL and MTHFR mRNA expression.
Collapse
|
10
|
Weng W, Zhang P, Ruan J, Zhang Y, Ba D, Tang Y. Prognostic significance of the tumor suppressor protein p53 gene in childhood acute lymphoblastic leukemia. Oncol Lett 2019; 19:549-556. [PMID: 31897170 DOI: 10.3892/ol.2019.11064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 08/08/2019] [Indexed: 12/12/2022] Open
Abstract
The tumor suppressor protein p53 (TP53) gene is associated with various types of cancer; however, little is known about TP53 expression in patients with childhood acute lymphoblastic leukemia (ALL). The aim of the present study was to investigate the prognostic value of TP53 expression in childhood ALL. To achieve this, TP53 mRNA levels of 146 children with ALL and 23 child donors with idiopathic thrombocytopenic purpura were determined by reverse transcription-quantitative PCR. Relapse-free survival (RFS) and overall survival (OS) were analyzed using the Kaplan-Meier method. The results demonstrated that TP53 mRNA level in patients with ALL was higher compared with that in the ITP donors (P=0.019). Patients with highly-expressed TP53 exhibited lower percentages of peripheral blood blast, higher platelet counts and inferior complete remission rates compared with patients with low expression of TP53. Survival analyses revealed that high TP53 expression was associated with poor OS and RFS in childhood ALL (P=0.018 and P=0.028, respectively) and was an independent prognostic factor in multivariate analysis for poor RFS (P<0.001) and OS (P<0.001). In conclusion, high TP53 expression is associated with poor outcomes and may be used as a molecular prognostic marker to be incorporated into an improved risk classification system for childhood ALL.
Collapse
Affiliation(s)
- Wenwen Weng
- Division of Hematology-Oncology, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, P.R. China
| | - Ping Zhang
- Division of Hematology-Oncology, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, P.R. China
| | - Jinfei Ruan
- Division of Hematology-Oncology, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, P.R. China
| | - Yao Zhang
- Division of Hematology-Oncology, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, P.R. China
| | - Diandian Ba
- Division of Hematology-Oncology, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, P.R. China
| | - Yongmin Tang
- Division of Hematology-Oncology, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, P.R. China
| |
Collapse
|
11
|
Zhang P, Weng WW, Chen P, Zhang Y, Ruan JF, Ba DD, Xu WQ, Tang YM. Low expression of TET2 gene in pediatric acute lymphoblastic leukemia is associated with poor clinical outcome. Int J Lab Hematol 2019; 41:702-709. [PMID: 31441600 DOI: 10.1111/ijlh.13099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/21/2019] [Accepted: 07/24/2019] [Indexed: 01/26/2023]
Abstract
INTRODUCTION TET2, a member of the Ten-Eleven translocation gene family, catalyzes the conversion of 5-methylcytosine to 5-hydroxymethylcytosine in DNA. Low expression of TET2 has been reported as a prognostic factor for several types of malignancies in adult patients. However, there have been few data on the effect of TET2 mRNA level on the prognosis of children with ALL so far. METHODS In this study, TET2 expression of samples cryopreserved in the liquid nitrogen from January 1, 2007 through December 31, 2011 was retrospectively analyzed in 136 newly diagnosed ALL patients by real-time polymerase chain reaction (PCR) assay. The patients' samples were divided into two groups by the median value of patients group and divided into TET2 low and TET2 high groups. RESULTS A total of 136 childhood ALL patients demonstrated lower TET2 expression than control group (P = .038). TET2 mRNA expression levels were correlated with the disease status. In addition, patients with low TET2 expression had lower platelet counts and lower CR rates. Survival analysis showed that low TET2 expression in children with ALL was associated with lower 5-year overall survival (OS) (63% vs 88%, P = .011) and event-free survival (EFS) (60% vs 85%, P = .003). Multivariate analysis revealed that low TET2 expression was an independent poor prognostic factor of OS and EFS. CONCLUSION Low expression of TET2 in children with ALL is associated with poor prognosis and can be used as a molecular prognostic marker for risk group stratification.
Collapse
Affiliation(s)
- Ping Zhang
- Division of Hematology-Oncology, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Wen-Wen Weng
- Division of Hematology-Oncology, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Ping Chen
- Division of Hematology-Oncology, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yao Zhang
- Division of Hematology-Oncology, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Jin-Fei Ruan
- Division of Hematology-Oncology, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Dian-Dian Ba
- Division of Hematology-Oncology, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Wei-Qun Xu
- Division of Hematology-Oncology, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yong-Min Tang
- Division of Hematology-Oncology, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
12
|
Minimal Residual Disease-guided Risk Restratification and Therapy Improves the Survival of Childhood Acute Lymphoblastic Leukemia: Experience From a Tertiary Children's Hospital in China. J Pediatr Hematol Oncol 2019; 41:e346-e354. [PMID: 30640823 DOI: 10.1097/mph.0000000000001412] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The minimal residual disease (MRD) has been shown to be very important to evaluate the prognostic significance in childhood acute lymphoblastic leukemia (ALL), but the impact under the current treatment protocol in China has not been fully elucidated. The aim of this study was to investigate the efficacy of MRD-guided risk restratification of ALL. A total of 676 children with ALL were enrolled. In the predictive study group, 476 patients were enrolled with 5-year cumulative incidence of relapse rates of the low-risk (LR), intermediate-risk (IR), and high-risk groups being 11.0%±2.3%, 12.6%±3.3%, and 32.7%±4.9%, respectively. In the intervention study group, 19/200 patients enrolled were reclassified into risk groups according to the MRD levels. The 3-year event-free survival and overall survival were 85.2%±2.9% and 90.6%±2.1%, respectively, which were higher than those of the predictive study group (79.1%±1.9% and 84.7%±1.7%, respectively; P<0.05). The 3-year cumulative incidence of relapse in the LR and IR groups of the intervention study group were 4.2%±3.1% and 6.4%±3.1%, respectively, which were significantly lower than those in the predictive study group (7.2%±1.8% and 11.8%±3.2%, respectively; P<0.05). We conclude that the risk of relapse in the LR and IR groups can be significantly reduced after MRD-guided risk restratification.
Collapse
|
13
|
Erdmann F, Feychting M, Mogensen H, Schmiegelow K, Zeeb H. Social Inequalities Along the Childhood Cancer Continuum: An Overview of Evidence and a Conceptual Framework to Identify Underlying Mechanisms and Pathways. Front Public Health 2019; 7:84. [PMID: 31106186 PMCID: PMC6492628 DOI: 10.3389/fpubh.2019.00084] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 03/26/2019] [Indexed: 12/13/2022] Open
Abstract
Inequalities in health according to social conditions are regarded as unnecessary and unjust. There is a large body of evidence on inequalities in adult cancer, observable throughout the societies on a national level as well as on a global scale. Socioeconomic influences on health matter at all ages including childhood, for which childhood cancer is the leading cause of disease related death in high-income countries (HICs). Substantial differences in the reported incidence of childhood cancers have been observed globally by socioeconomic development of a population. This is reflected in the higher incidence rates reported for HICs, particularly for acute lymphoblastic leukemia, and for cancer in infants (below 1 year), compared to low- and middle-income countries (LMICs). Considerable inequalities between populations and degree of socioeconomic development are also noted for survival from childhood cancer, with substantially lower survival rates seen in most LMICs compared to HICs. With respect to inequalities by socioeconomic position (SEP) within countries, findings of an association between SEP and childhood cancer risk are diverse and limited to studies from HICs. On the contrary, observations on social inequalities in survival within countries are accumulating and indicate that survival inequalities do not only concern resource-poor countries but also high-income populations including European countries. In turn, a childhood cancer diagnosis in itself may have implications on the parents' socioeconomic situation as well as on the later socioeconomic life after having survived the disease. The underlying mechanisms and causal pathways of these empirically demonstrated social inequalities are poorly understood, although it is of significant public health relevance for any actions or strategies to reduce childhood cancer-related inequity. We propose a conceptual framework on potential underlying mechanism and pathways specifically addressing social inequalities in childhood cancer and after childhood cancer to (i) illustrate potential pathways by which social determinants may create health inequities at different points of the childhood cancer continuum; (ii) illustrate potential pathways by which a childhood cancer diagnosis may impact the socioeconomic situation of the concerned family or the later life of a childhood survivor; and (iii) point out how major determinants may relate to each other.
Collapse
Affiliation(s)
- Friederike Erdmann
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France
- Department of Prevention and Evaluation, Leibniz - Institute for Prevention Research and Epidemiology - BIPS GmbH, Bremen, Germany
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Maria Feychting
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hanna Mogensen
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz - Institute for Prevention Research and Epidemiology - BIPS GmbH, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
| |
Collapse
|
14
|
Shen S, Cai J, Chen J, Xue H, Pan C, Gao Y, Tang Y, Wang J, Li B, Wang X, Chen J, Gu L, Tang J. Long-term results of the risk-stratified treatment of childhood acute lymphoblastic leukemia in China. Hematol Oncol 2018; 36:679-688. [DOI: 10.1002/hon.2541] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 07/22/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Shuhong Shen
- Department of Hematology/Oncology, Shanghai Children's Medical Center; Shanghai Jiao Tong University School of Medicine, Key Lab of Pediatric Hematology & Oncology of China Ministry of Health; Shanghai China
| | - Jiaoyang Cai
- Department of Hematology/Oncology, Shanghai Children's Medical Center; Shanghai Jiao Tong University School of Medicine, Key Lab of Pediatric Hematology & Oncology of China Ministry of Health; Shanghai China
| | - Jing Chen
- Department of Hematology/Oncology, Shanghai Children's Medical Center; Shanghai Jiao Tong University School of Medicine, Key Lab of Pediatric Hematology & Oncology of China Ministry of Health; Shanghai China
| | - Huiliang Xue
- Department of Hematology/Oncology, Shanghai Children's Medical Center; Shanghai Jiao Tong University School of Medicine, Key Lab of Pediatric Hematology & Oncology of China Ministry of Health; Shanghai China
| | - Ci Pan
- Department of Hematology/Oncology, Shanghai Children's Medical Center; Shanghai Jiao Tong University School of Medicine, Key Lab of Pediatric Hematology & Oncology of China Ministry of Health; Shanghai China
| | - Yijin Gao
- Department of Hematology/Oncology, Shanghai Children's Medical Center; Shanghai Jiao Tong University School of Medicine, Key Lab of Pediatric Hematology & Oncology of China Ministry of Health; Shanghai China
| | - Yanjing Tang
- Department of Hematology/Oncology, Shanghai Children's Medical Center; Shanghai Jiao Tong University School of Medicine, Key Lab of Pediatric Hematology & Oncology of China Ministry of Health; Shanghai China
| | - Jianmin Wang
- Department of Hematology/Oncology, Shanghai Children's Medical Center; Shanghai Jiao Tong University School of Medicine, Key Lab of Pediatric Hematology & Oncology of China Ministry of Health; Shanghai China
| | - Benshang Li
- Department of Hematology/Oncology, Shanghai Children's Medical Center; Shanghai Jiao Tong University School of Medicine, Key Lab of Pediatric Hematology & Oncology of China Ministry of Health; Shanghai China
| | - Xiang Wang
- Department of Hematology/Oncology, Shanghai Children's Medical Center; Shanghai Jiao Tong University School of Medicine, Key Lab of Pediatric Hematology & Oncology of China Ministry of Health; Shanghai China
| | - Jing Chen
- Department of Hematology/Oncology, Shanghai Children's Medical Center; Shanghai Jiao Tong University School of Medicine, Key Lab of Pediatric Hematology & Oncology of China Ministry of Health; Shanghai China
| | - Longjun Gu
- Department of Hematology/Oncology, Shanghai Children's Medical Center; Shanghai Jiao Tong University School of Medicine, Key Lab of Pediatric Hematology & Oncology of China Ministry of Health; Shanghai China
| | - Jingyan Tang
- Department of Hematology/Oncology, Shanghai Children's Medical Center; Shanghai Jiao Tong University School of Medicine, Key Lab of Pediatric Hematology & Oncology of China Ministry of Health; Shanghai China
| |
Collapse
|
15
|
Vasquez L, Diaz R, Chavez S, Tarrillo F, Maza I, Hernandez E, Oscanoa M, García J, Geronimo J, Rossell N. Factors associated with abandonment of therapy by children diagnosed with solid tumors in Peru. Pediatr Blood Cancer 2018; 65:e27007. [PMID: 29431252 DOI: 10.1002/pbc.27007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 01/16/2018] [Accepted: 01/19/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Abandonment of treatment is a major cause of treatment failure and poor survival in children with cancer in low- and middle-income countries. The incidence of treatment abandonment in Peru has not been reported. The aim of this study was to examine the prevalence of and factors associated with treatment abandonment by pediatric patients with solid tumors in Peru. METHODS We retrospectively reviewed the sociodemographic and clinical data of children referred between January 2012 and December 2014 to the two main tertiary centers for childhood cancer in Peru. The definition of treatment abandonment followed the International Society of Paediatric Oncology, Paediatric Oncology in Developing Countries, Abandonment of Treatment recommendation. RESULTS Data from 1135 children diagnosed with malignant solid tumors were analyzed, of which 209 (18.4%) abandoned treatment. Bivariate logistic regression analysis showed significantly higher abandonment rates in children living outside the capital city, Lima (forest; odds ratio [OR] 3.25; P < 0.001), those living in a rural setting (OR 3.44; P < 0.001), and those whose parent(s) lacked formal employment (OR 4.39; P = 0.001). According to cancer diagnosis, children with retinoblastoma were more likely to abandon treatment compared to children with other solid tumors (OR 1.79; P = 0.02). In multivariate regression analyses, rural origin (OR 2.02; P = 0.001) and lack of formal parental employment (OR 2.88; P = 0.001) were independently predictive of abandonment. CONCLUSION Treatment abandonment prevalence of solid tumors in Peru is high and closely related to sociodemographical factors. Treatment outcomes could be substantially improved by strategies that help prevent abandonment of therapy based on these results.
Collapse
Affiliation(s)
- Liliana Vasquez
- Pediatric Oncology Unit, Edgardo Rebagliati Martins Hospital, Lima, Peru
| | - Rosdali Diaz
- Pediatric Oncology, National Institute of Neoplastic Diseases, Lima, Peru
| | - Sharon Chavez
- Pediatric Oncology, National Institute of Neoplastic Diseases, Lima, Peru
| | - Fanny Tarrillo
- Pediatric Oncology Unit, Edgardo Rebagliati Martins Hospital, Lima, Peru
| | - Ivan Maza
- Pediatric Oncology Unit, Edgardo Rebagliati Martins Hospital, Lima, Peru
| | - Eddy Hernandez
- Pediatric Oncology, National Institute of Neoplastic Diseases, Lima, Peru
| | - Monica Oscanoa
- Pediatric Oncology Unit, Edgardo Rebagliati Martins Hospital, Lima, Peru
| | - Juan García
- Pediatric Oncology, National Institute of Neoplastic Diseases, Lima, Peru
| | - Jenny Geronimo
- Pediatric Oncology Unit, Edgardo Rebagliati Martins Hospital, Lima, Peru
| | - Nuria Rossell
- Amsterdam Institute for Social Sciences Research, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
16
|
Trehan A, Bansal D, Varma N, Vora A. Improving outcome of acute lymphoblastic leukemia with a simplified protocol: report from a tertiary care center in north India. Pediatr Blood Cancer 2017; 64. [PMID: 27762058 DOI: 10.1002/pbc.26281] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 09/01/2016] [Accepted: 09/01/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND The outcome of malignancies in low- and middle-income countries (LMICs) is hampered owing to numerous factors. Current protocols are complex, demanding supportive care, often not optimally available. We de-escalated the UKALL 2003 protocol to improve the outcome of acute lymphoblastic leukemia (ALL) at our center. METHODS In 2007-2009, children were treated as per the UKALL 2003 protocol (protocol 1). In 2010 and 2011, a modified version of the UKALL 2003 (protocol 2) was followed. RESULTS Three hundred and seventy-four children aged 5.71+3.1 (1-13) years were treated. Remission was achieved in 335 of the 338 who completed induction. Treatment-related mortality decreased significantly with the modified protocol (P ≤ 0.001). Relapses were similar with both protocols. Protocol used, regimen, counts at diagnosis, weight for age, gender, education of parents and occupation of caregiver were associated with the outcome of death (P < 0.05). On Cox proportional hazard analysis, patients on protocol 1, female gender and weight ≤5th centile had a greater hazard of dying (0.46 [P < 0.0001]; 1.5 [P = 0.04] and 1.64 [P = 0.01]). The 3 years overall survival (OS) with protocols 1 and 2 was 54.8% (95% CI 47.4-61.7%) and 73.9% (95% CI 66-79%) (P < 0.001), respectively. The event-free survival with protocols 1 and 2 was 50.8% (95% CI 43-57%) and 65.7% (95% CI 58-72%) (P < 0.001), respectively. CONCLUSIONS A steady improvement in survival has been observed at our center to a 3-year present OS of 73.9% with reduction in treatment intensity. The way forward for LMICs is to formulate rational treatment protocols at par with resources.
Collapse
Affiliation(s)
- Amita Trehan
- Pediatric Hematology Oncology Unit, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Bansal
- Pediatric Hematology Oncology Unit, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neelam Varma
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Vora
- Department of Pediatric Hematology, Sheffield Children's Hospital, Sheffield, United Kingdom
| |
Collapse
|
17
|
Determinants of Treatment Abandonment in Childhood Cancer: Results from a Global Survey. PLoS One 2016; 11:e0163090. [PMID: 27736871 PMCID: PMC5063311 DOI: 10.1371/journal.pone.0163090] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 09/03/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Understanding and addressing treatment abandonment (TxA) is crucial for bridging the pediatric cancer survival gap between high-income (HIC) and low-and middle-income countries (LMC). In childhood cancer, TxA is defined as failure to start or complete curative cancer therapy and known to be a complex phenomenon. With rising interest on causes and consequences of TxA in LMC, this study aimed to establish the lay-of-the-land regarding determinants of TxA globally, perform and promote comparative research, and raise awareness on this subject. METHODS Physicians (medical oncologists, surgeons, and radiation therapists), nurses, social workers, and psychologists involved in care of children with cancer were approached through an online survey February-May 2012. Queries addressed social, economic, and treatment-related determinants of TxA. Free-text comments were collected. Descriptive and qualitative analyses were performed. Appraisal of overall frequency, burden, and predictors of TxA has been reported separately. RESULTS 581 responses from 101 countries were obtained (contact rate = 26%, cooperation rate = 70%). Most respondents were physicians (86%), practicing pediatric hematology/oncology (86%) for >10 years (54%). Providers from LMC considered social/economic factors (families' low socioeconomic status, low education, and long travel time), as most influential in increasing risk of TxA. Treatment-related considerations such as preference for complementary and alternative medicine and concerns about treatment adverse effects and toxicity, were perceived to play an important role in both LMC and HIC. Perceived prognosis seemed to mediate the role of other determinants such as diagnosis and treatment phase on TxA risk. For example, high-risk of TxA was most frequently reported when prognosis clearly worsened (i.e. lack of response to therapy, relapse), or conversely when the patient appeared improved (i.e. induction completed, mass removed), as well as before aggressive/mutilating surgery. Provider responses allowed development of an expanded conceptual model of determinants of TxA; one which illustrates established and emerging individual, family, center, and context specific factors to be considered in order to tackle this problem. Emerging factors included vulnerability, family dynamics, perceptions, center capacity, public awareness, and governmental healthcare financing, among others. CONCLUSION TxA is a complex and multifactorial phenomenon. With increased recognition of the role of TxA on global pediatric cancer outcomes, factors beyond social/economic status and beliefs have emerged. Our results provide insights regarding the role of established determinants of TxA in different geographical and economic contexts, allow probing of key determinants by deliberating their mechanisms, and allow building an expanded conceptual model of established and emerging determinants TxA.
Collapse
|
18
|
A 10-Year Follow-up Survey of Treatment Abandonment of Children With Acute Myeloid Leukemia in Suzhou, China. J Pediatr Hematol Oncol 2016; 38:437-42. [PMID: 27322718 DOI: 10.1097/mph.0000000000000601] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A survey of the clinical data on acute myeloid leukemia (AML) over the past 10 years in the treatment center of Children's Hospital was presented. The aim of the study was to identify the factors influencing the treatment abandonment rate (AR) of AML. Of the 474 AML cases examined, 264 were abandoned (55.7%). The most important factor affecting AR appeared to be the AML subtype-that is, the M3 versus non-M3 (42% vs. 60%). Patient age was observed to be closely related to AR-the older the patients, the lower the AR-and infants had the highest prevalence of abandonment (84.2%). The patient's residential location was markedly correlated to AR, which was almost inversely proportional to the size of the township where the patient came from. From large cities, intermediate and small towns to countryside villages, the AR increased linearly. So was the correlation with health insurance coverage, which decreased in the same way. Sex and karyotypes did not affect AR. In conclusion, the patients' financial burden and the perceived incurability of AML were the 2 leading factors dominating the decision for abandonment in parents and caregivers.
Collapse
|
19
|
Viana SS, de Lima LMMR, do Nascimento JB, Cardoso CAF, Rosário ACD, Mendonça CDQ, de Menezes-Neto OA, Cipolotti R. Secular trends and predictors of mortality in acute lymphoblastic leukemia for children of low socioeconomic level in Northeast Brazil. Leuk Res 2015; 39:1060-5. [DOI: 10.1016/j.leukres.2015.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 07/09/2015] [Accepted: 07/16/2015] [Indexed: 11/30/2022]
|
20
|
Friedrich P, Lam CG, Itriago E, Perez R, Ribeiro RC, Arora RS. Magnitude of Treatment Abandonment in Childhood Cancer. PLoS One 2015; 10:e0135230. [PMID: 26422208 PMCID: PMC4589240 DOI: 10.1371/journal.pone.0135230] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 07/20/2015] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Treatment abandonment (TxA) is recognized as a leading cause of treatment failure for children with cancer in low-and-middle-income countries (LMC). However, its global frequency and burden have remained elusive due to lack of global data. This study aimed to obtain an estimate using survey and population data. METHODS Childhood cancer clinicians (medical oncologists, surgeons, and radiation therapists), nurses, social workers, and psychologists involved in care of children with cancer were approached through an online survey February-May 2012. Incidence and population data were obtained from public sources. Descriptive, univariable, and multivariable analyses were conducted. RESULTS 602 responses from 101 countries were obtained from physicians (84%), practicing pediatric hematology/oncology (83%) in general or children's hospitals (79%). Results suggested, 23,854 (15%) of 155,088 children <15 years old newly diagnosed with cancer annually in the countries analyzed, abandon therapy. Importantly, 83% of new childhood cancer cases and 99% of TxA were attributable to LMC. The annual number of cases of TxA expected in LMC worldwide (26,166) was nearly equivalent to the annual number of cancer cases in children <15 years expected in HIC (26,368). Approximately two thirds of LMC had median TxA ≥ 6%, but TxA ≥ 6% was reported in high- (9%), upper-middle- (41%), lower-middle- (80%), and low-income countries (90%, p<0.001). Most LMC centers reporting TxA > 6% were outside the capital. Lower national income category, higher reliance on out-of-pocket payments, and high prevalence of economic hardship at the center were independent contextual predictors for TxA ≥ 6% (p<0.001). Global survival data available for more developed and less developed regions suggests TxA may account for at least a third of the survival gap between HIC and LMC. CONCLUSION Results show TxA is prevalent (compromising cancer survival for 1 in 7 children globally), confirm the suspected high burden of TxA in LMC, and illustrate the negative impact of poverty on its occurrence. The present estimates may appear small compared to the global burden of child death from malnutrition and infection (measured in millions). However, absolute numbers suggest the burden of TxA in LMC is nearly equivalent to annually losing all kids diagnosed with cancer in HIC just to TxA, without even considering deaths from disease progression, relapse or toxicity-the main causes of childhood cancer mortality in HIC. Results document the importance of monitoring and addressing TxA as part of childhood cancer outcomes in at-risk settings.
Collapse
Affiliation(s)
- Paola Friedrich
- Department of Pediatric Oncology, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusetts, United States of America
| | - Catherine G. Lam
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States of America
- International Outreach Program, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States of America
| | - Elena Itriago
- Department of Pediatric Oncology, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusetts, United States of America
| | - Rafael Perez
- Villa Victoria Center for the Arts, Boston, Massachusetts, United States of America
| | - Raul C. Ribeiro
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States of America
| | | |
Collapse
|
21
|
Jia M, Zhao HZ, Cheng YP, Luo ZB, Zhang JY, Li SS, Xu XJ, Tang YM. High expression of Midkine (MK) indicates poor prognosis in childhood acute lymphoblastic leukemia. ACTA ACUST UNITED AC 2015; 21:69-77. [PMID: 26352402 DOI: 10.1179/1607845415y.0000000050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Midkine (MK) expression has been reported to be correlated with the poor prognosis of patients with various tumors. However, there are no data available about the prognostic value of MK expression in childhood acute lymphoblastic leukemia (ALL). METHODS In this study, MK mRNA expression was determined by real-time polymerase chain reaction in 120 childhood ALL and 30 healthy volunteers. Patients were dichotomized at the median value and divided into two groups: MK(low) group and MK(high) group. RESULTS MK(high) patients had higher white blood cell counts, higher peripheral blood blasts percentages, and higher minimal residual disease levels than MK(low) patients. Moreover, the MK gene was expressed significantly higher in patients with relapsed ALL than in patients who maintained complete remission or at diagnosis. MK(high) patients harbored inferior relapse-free survival (RFS, P = 0.047) and overall survival (OS, P = 0.022) than MK(low) patients, and high expression of MK was found to be independently predictive of inferior OS (P = 0.032) but not RFS (P = 0.077) in the overall cohort. CONCLUSION AND DISCUSSION MK high expression is an independent adverse prognostic factor in childhood ALL. Its level may be incorporated into an improved risk classification system for ALL and suggest the need of alternative regimens.
Collapse
Affiliation(s)
- Ming Jia
- a Division of Hematology-Oncology , Children's Hospital of Zhejiang University School of Medicine, Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education , Hangzhou 310003 , PR China
| | - Hai-Zhao Zhao
- a Division of Hematology-Oncology , Children's Hospital of Zhejiang University School of Medicine, Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education , Hangzhou 310003 , PR China
| | - Yu-Ping Cheng
- a Division of Hematology-Oncology , Children's Hospital of Zhejiang University School of Medicine, Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education , Hangzhou 310003 , PR China
| | - Ze-Bin Luo
- a Division of Hematology-Oncology , Children's Hospital of Zhejiang University School of Medicine, Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education , Hangzhou 310003 , PR China
| | - Jing-Ying Zhang
- a Division of Hematology-Oncology , Children's Hospital of Zhejiang University School of Medicine, Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education , Hangzhou 310003 , PR China
| | - Si-Si Li
- a Division of Hematology-Oncology , Children's Hospital of Zhejiang University School of Medicine, Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education , Hangzhou 310003 , PR China
| | - Xiao-Jun Xu
- a Division of Hematology-Oncology , Children's Hospital of Zhejiang University School of Medicine, Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education , Hangzhou 310003 , PR China
| | - Yong-Min Tang
- a Division of Hematology-Oncology , Children's Hospital of Zhejiang University School of Medicine, Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education , Hangzhou 310003 , PR China
| |
Collapse
|
22
|
Methotrexate Associated Renal Impairment Is Related to Delayed Elimination of High-Dose Methotrexate. ScientificWorldJournal 2015; 2015:751703. [PMID: 26185782 PMCID: PMC4491404 DOI: 10.1155/2015/751703] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 06/08/2015] [Indexed: 11/21/2022] Open
Abstract
Although Methotrexate (MTX) is an effective drug for the treatment of acute lymphoblastic leukemia (ALL), the toxicity remains a significant problem. In this prospective study, fifty-four patients with ALL were enrolled. 3 g or 5 g MTX/m2 was administered over 24 hours. Serum MTX concentrations were determined in 24, 48, and 96 hours after MTX infusion. Serum creatinine concentrations and creatinine clearance rate (CCR) were determined before and 24 and 48 hours after MTX infusion. A total of 173 courses of MTX infusion were administered. The serum creatinine concentrations did not change much after MTX infusion while the CCR was gradually decreased. MTX clearance status was independently related to CCR decrease, with the risk of 8.07 to develop renal impairment in patients with delayed MTX elimination. Serum creatinine concentration, serum creatinine ratio, CCR, and CCR ratio at 24 hours were all related to MTX elimination delay. Patients with serum creatinine level >35.0 μmol/L, creatinine ratio >1.129, or CCR <100.0 mL/min were more likely to undergo MTX elimination delay. In conclusion, MTX could induce transient renal impairment and compromised renal function will delay MTX clearance. The serum creatinine concentration and the ratio and CCR are useful tools for evaluating MTX elimination status.
Collapse
|
23
|
Jia M, Zhao HZ, Shen HP, Cheng YP, Luo ZB, Li SS, Zhang JY, Tang YM. Overexpression of lymphoid enhancer-binding factor-1 (LEF1) is a novel favorable prognostic factor in childhood acute lymphoblastic leukemia. Int J Lab Hematol 2015; 37:631-40. [PMID: 25955539 DOI: 10.1111/ijlh.12375] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 03/26/2015] [Indexed: 12/23/2022]
Affiliation(s)
- M. Jia
- Division of Hematology-oncology; Children's Hospital of Zhejiang University School of Medicine; Key Laboratory of Reproductive Genetics (Zhejiang University); Ministry of Education; Hangzhou China
| | - H.-Z. Zhao
- Division of Hematology-oncology; Children's Hospital of Zhejiang University School of Medicine; Key Laboratory of Reproductive Genetics (Zhejiang University); Ministry of Education; Hangzhou China
| | - H.-P. Shen
- Division of Hematology-oncology; Children's Hospital of Zhejiang University School of Medicine; Key Laboratory of Reproductive Genetics (Zhejiang University); Ministry of Education; Hangzhou China
| | - Y.-P. Cheng
- Division of Hematology-oncology; Children's Hospital of Zhejiang University School of Medicine; Key Laboratory of Reproductive Genetics (Zhejiang University); Ministry of Education; Hangzhou China
| | - Z.-B. Luo
- Division of Hematology-oncology; Children's Hospital of Zhejiang University School of Medicine; Key Laboratory of Reproductive Genetics (Zhejiang University); Ministry of Education; Hangzhou China
| | - S.-S. Li
- Division of Hematology-oncology; Children's Hospital of Zhejiang University School of Medicine; Key Laboratory of Reproductive Genetics (Zhejiang University); Ministry of Education; Hangzhou China
| | - J.-Y. Zhang
- Division of Hematology-oncology; Children's Hospital of Zhejiang University School of Medicine; Key Laboratory of Reproductive Genetics (Zhejiang University); Ministry of Education; Hangzhou China
| | - Y.-M. Tang
- Division of Hematology-oncology; Children's Hospital of Zhejiang University School of Medicine; Key Laboratory of Reproductive Genetics (Zhejiang University); Ministry of Education; Hangzhou China
| |
Collapse
|
24
|
Zhou Q, Hong D, Lu J, Zheng D, Ashwani N, Hu S. Pediatric Medical Care System in China Has Significantly Reduced Abandonment of Acute Lymphoblastic Leukemia Treatment. J Pediatr Hematol Oncol 2015; 37:181-4. [PMID: 25393454 PMCID: PMC4368124 DOI: 10.1097/mph.0000000000000285] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In this study, we have analyzed both administrative and clinical data from our hospital during 2002 to 2012 to evaluate the influence of government medical policies on reducing abandonment treatment in pediatric patients with acute lymphoblastic leukemia. Two policies funding for the catastrophic diseases and the new rural cooperative medical care system (NRCMS) were initiated in 2005 and 2011, respectively. About 1151 children diagnosed with acute lymphoblastic leukemia were enrolled in our study during this period and 316 cases abandoned treatment. Statistical differences in sex, age, number of children in the family, and family financial status were observed. Of most importance, the medical insurance coverage was critical for reducing abandonment treatment. However, 92 cases abandoning treatment after relapse did not show significant difference either in medical insurance coverage or in duration from first complete remission. In conclusion, financial crisis was the main reason for abandoning treatment. Government-funded health care expenditure programs reduced families' economic burden and thereby reduced the abandonment rate with resultant increased overall survival.
Collapse
Affiliation(s)
- Qi Zhou
- The Children’s Hospital of Soochow University
| | - Dan Hong
- The Children’s Hospital of Soochow University
| | - Jun Lu
- The Children’s Hospital of Soochow University
| | - Defei Zheng
- The Children’s Hospital of Soochow University
| | | | - Shaoyan Hu
- The Children’s Hospital of Soochow University,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| |
Collapse
|
25
|
Petridou ET, Sergentanis TN, Perlepe C, Papathoma P, Tsilimidos G, Kontogeorgi E, Kourti M, Baka M, Moschovi M, Polychronopoulou S, Sidi V, Hatzipantelis E, Stiakaki E, Iliadou AN, La Vecchia C, Skalkidou A, Adami HO. Socioeconomic disparities in survival from childhood leukemia in the United States and globally: a meta-analysis. Ann Oncol 2015; 26:589-597. [PMID: 25527416 DOI: 10.1093/annonc/mdu572] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Despite advancements in the treatment of childhood leukemia, socioeconomic status (SES) may potentially affect disease prognosis. This study aims to evaluate whether SES is associated with survival from childhood leukemia. METHODS The US National Cancer Institute Surveillance, Epidemiology and End Results Program (SEER) 1973-2010 data were analyzed; thereafter, results were meta-analyzed along with those from survival (cohort) studies examining the association between SES indices and survival from childhood leukemia (end-of-search date: 31 March 2014). Random-effects models were used to calculate pooled effect estimates (relative risks, RRs); meta-regression was also used. RESULTS We included 29 studies yielding 28 804 acute lymphoblastic leukemia (ALL), 3208 acute myeloblastic leukemia (AML) and 27 650 'any' leukemia (denoting joint reporting of all subtypes) cases. According to individual-level composite SES indices, children from low SES suffered from nearly twofold higher death rates from ALL (pooled RR: 1.83, 95% confidence interval 1.00-3.34, based on four study arms); likewise, death RRs derived from an array of lower area-level SES indices ranged between 1.17 and 1.33 (based on 11 study arms). Importantly, the survival gap between higher and lower SES seemed wider in the United States, with considerably (by 20%-82%) increased RRs for death from ALL in lower SES. Regarding AML, poorer survival was evident only when area-level SES indices were used. Lastly, remoteness indices were not associated with survival from childhood leukemia. CONCLUSION Children with lower SES suffering childhood leukemia do not seem to equally enjoy the impressive recent survival gains. Special health policy strategies and increased awareness of health providers might minimize the effects of socioeconomic disparities.
Collapse
Affiliation(s)
- E T Petridou
- Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens
| | - T N Sergentanis
- Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens
| | - C Perlepe
- Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens
| | - P Papathoma
- Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens
| | - G Tsilimidos
- Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens
| | - E Kontogeorgi
- Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens
| | - M Kourti
- Hematology-Oncology Unit, Department of Pediatric Oncology, Hippokration Hospital, Thessaloniki
| | - M Baka
- Department of Pediatric Hematology-Oncology, 'Pan. & Agl. Kyriakou' Children's Hospital, Athens
| | - M Moschovi
- First Department of Pediatrics, Athens University Medical School
| | - S Polychronopoulou
- Department of Pediatric Hematology-Oncology, 'Aghia Sophia' General Children's Hospital, Athens
| | - V Sidi
- Hematology-Oncology Unit, Department of Pediatric Oncology, Hippokration Hospital, Thessaloniki
| | - E Hatzipantelis
- 2nd Department of Pediatrics, Aristotelion University of Thessaloniki, AHEPA General Hospital, Thessaloniki
| | - E Stiakaki
- Department of Pediatric Hematology-Oncology, University Hospital of Heraklion, Heraklion, Greece
| | - A N Iliadou
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - C La Vecchia
- Department of Epidemiology, Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
| | - A Skalkidou
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - H O Adami
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden Department of Epidemiology, Harvard School of Public Health, Boston, USA
| |
Collapse
|
26
|
Comparison of long-term outcome between white and Vietnamese children treated for acute lymphoblastic leukemia according to the FRALLE 2000 protocol. J Pediatr Hematol Oncol 2014; 36:534-40. [PMID: 24322500 DOI: 10.1097/mph.0000000000000062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM OF THIS STUDY To compare the relapse-free survival (RFS) in Vietnamese (n=141) and white (n=94) children living in Vietnam and Belgium, respectively, and treated in their own country for acute lymphoblastic leukemia according to the same FRALLE 2000 protocol. RESULTS RFS was significantly worse in Vietnamese children (hazards ratio=4.48; 95% confidence interval [CI], 2.16-9.3; P<0.01). The 5-year RFS was 83.8% (95% CI, 76.3%-92.0%) and 47.8% (95% CI, 35.6%-64.2%) for white and Vietnamese children, respectively. In the latter group, relapses occurred in bone marrow and cerebrospinal fluid at a much earlier stage. The outcome was compared at first relapse only because of different treatments afterward, according to the country. Both series were similar for sex, age at diagnosis, initial white blood cell count, cytogenetic abnormalities, and corticosensitivity at day 8. Higher frequency of L2-acute lymphoblastic leukemia (P<0.001) but lower frequency of T-acute lymphoblastic leukemia (P=0.004) were observed in Vietnamese children. CONCLUSIONS Several factors may contribute to the poor RFS in Vietnamese children, which include the time interval before the first intrathecal therapy and differences in the management of drug-related toxicity. However, additional contribution of socioeconomic factors and/or variations in pharmacogenetic polymorphisms in Vietnamese patients cannot currently be ruled out.
Collapse
|
27
|
Gao YJ, Pan C, Tang JY, Lu FJ, Chen J, Xue HL, Zhai XW, Li J, Ye QD, Zhou M, Wang HS, Miao H, Qian XW, Xu Z, Meng JH. Clinical outcome of childhood lymphoblastic lymphoma in Shanghai China 2001-2010. Pediatr Blood Cancer 2014; 61:659-63. [PMID: 24243691 DOI: 10.1002/pbc.24848] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 10/14/2013] [Indexed: 01/07/2023]
Abstract
BACKGROUND This retrospective cohort study analysed the clinical characteristics and outcomes of patients with childhood lymphoblastic lymphoma (LBL) treated in Shanghai, China. PROCEDURE From 2001 to 2010, 108 evaluable patients ≤16 years of age who were newly diagnosed with biopsy-proven LBL were treated with one of three treatment protocols: CCCG-99, SCMC-T-NHL-2002, or LBL-CHOF-2006. RESULTS Two patients had Stage I disease, 5 had Stage II, 55 had Stage III, and 46 had Stage IV. The immunophenotype was T-cell LBL in 92 patients (85.2%) and precursor B-cell LBL in 16 (14.8%). The abandonment rate was 11.5%. Twenty-five patients (23.2%) suffered from resistant disease, including 1 with isolated central nervous system (CNS) relapse. At a median follow-up of 40.4 months (range, 0-114 months), the 5-year probability of event-free survival (pEFS) was 63.9 ± 4.6% in all patients. The 5-year pEFS for patients with pB-LBL was better than for patients with T-LBL (100% vs. 61.3 ± 5.1%, P = 0.007). Patients who had achieved complete remission on day 33 of induction had significantly better pEFS than those who had not (78.8 ± 4.6% vs. 28.2 ± 9.0%, P = 0.000). Three of 25 patients who experienced resistant disease were alive at the end of the study period. CONCLUSIONS The abandonment rate was lower for patients with LBL than for patients with acute lymphoblastic leukemia. Prophylactic cranial radiation can be omitted for patients with LBL even when advanced-stage disease is present, as intensive systemic chemotherapy with intrathecal therapy is sufficient to prevent CNS relapse. The survival of patients with resistant disease was very poor.
Collapse
Affiliation(s)
- Yi-Jin Gao
- Children's Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Gupta S, Wilejto M, Pole JD, Guttmann A, Sung L. Low socioeconomic status is associated with worse survival in children with cancer: a systematic review. PLoS One 2014; 9:e89482. [PMID: 24586813 PMCID: PMC3935876 DOI: 10.1371/journal.pone.0089482] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 01/21/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND While low socioeconomic status (SES) has been associated with inferior cancer outcome among adults, its impact in pediatric oncology is unclear. Our objective was therefore to conduct a systematic review to determine the impact of SES upon outcome in children with cancer. METHODS We searched Ovid Medline, EMBASE and CINAHL from inception to December 2012. Studies for which survival-related outcomes were reported by socioeconomic subgroups were eligible for inclusion. Two reviewers independently assessed articles and extracted data. Given anticipated heterogeneity, no quantitative meta-analyses were planned a priori. RESULTS Of 7,737 publications, 527 in ten languages met criteria for full review; 36 studies met final inclusion criteria. In low- and middle-income countries (LMIC), lower SES was uniformly associated with inferior survival, regardless of the measure chosen. The majority of associations were statistically significant. Of 52 associations between socioeconomic variables and outcome among high-income country (HIC) children, 38 (73.1%) found low SES to be associated with worse survival, 15 of which were statistically significant. Of the remaining 14 (no association or high SES associated with worse survival), only one was statistically significant. Both HIC studies examining the effect of insurance found uninsured status to be statistically associated with inferior survival. CONCLUSIONS Socioeconomic gradients in which low SES is associated with inferior childhood cancer survival are ubiquitous in LMIC and common in HIC. Future studies should elucidate mechanisms underlying these gradients, allowing the design of interventions mediating socioeconomic effects. Targeting the effect of low SES will allow for further improvements in childhood cancer survival.
Collapse
Affiliation(s)
- Sumit Gupta
- Division of Haematology/Oncology, the Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Program in Child Health Evaluative Sciences, the Hospital for Sick Children, Toronto, Ontario, Canada
- Institute for Health, Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Marta Wilejto
- Division of Haematology/Oncology, the Hospital for Sick Children, Toronto, Ontario, Canada
- Program in Child Health Evaluative Sciences, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jason D. Pole
- Pediatric Oncology Group of Ontario, Toronto, Ontario, Canada
- Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada
| | - Astrid Guttmann
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada
- Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
- Institute for Health, Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Lillian Sung
- Division of Haematology/Oncology, the Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Program in Child Health Evaluative Sciences, the Hospital for Sick Children, Toronto, Ontario, Canada
- Institute for Health, Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
29
|
Xu WQ, Zhang LY, Chen XY, Pan BH, Mao JQ, Song H, Li JY, Tang YM. Serum creatinine and creatinine clearance for predicting plasma methotrexate concentrations after high-dose methotrexate chemotherapy for the treatment for childhood lymphoblastic malignancies. Cancer Chemother Pharmacol 2013; 73:79-86. [PMID: 24158402 DOI: 10.1007/s00280-013-2319-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 10/09/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Monitoring of plasma methotrexate (MTX) concentrations allows for therapeutic adjustments in treating childhood acute lymphoblastic leukemia (ALL) or non-Hodgkin lymphoma (NHL) with high-dose MTX (HDMTX). We tested the hypothesis that assessment of creatinine clearance (CrCl) and/or serum Cr may be a suitable means of monitoring plasma MTX concentrations. METHODS All children in the study had ALL or NHL, were in complete remission, and received HDMTX (3 or 5 g/m(2))+leucovorin. Plasma MTX concentrations were measured at 24, 48, and 96 h. CrCl was determined at 24 and 48 h. Correlations between 24- and 48-h plasma MTX concentrations and CrCl and serum Cr concentrations were determined. CrCl and serum Cr concentrations were compared over time between children who had delayed and non-delayed MTX elimination. RESULTS A total of 105 children were included. There were significant negative correlations between CrCl at 24 and 48 h and plasma MTX concentrations at 24 (both p < 0.001) and 48 h (both p < 0.001). There were significant positive correlations between serum Cr concentrations at both 24 and 48 h and plasma MTX concentrations at 24 (both p < 0.001) and 48 h (both p < 0.001). There were 88 (30.2 %) instances of elimination delay. Children with elimination delay had significantly lower CrCl and higher Cr concentrations at 24 and 48 h compared with children without elimination delay (all p < 0.05). CONCLUSION Our findings suggest that, with further refinement, assessment of renal function may be a useful means of monitoring plasma MTX concentrations during HDMTX for ALL and NHL.
Collapse
Affiliation(s)
- Wei-qun Xu
- Division of Hematology-Oncology, Children's Hospital of Zhejiang University, School of Medicine, #57 Zhuganxiang Road, Yan-an Street, Hangzhou, 310003, People's Republic of China
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Gupta S, Yeh S, Martiniuk A, Lam CG, Chen HY, Liu YL, Tsimicalis A, Arora RS, Ribeiro RC. The magnitude and predictors of abandonment of therapy in paediatric acute leukaemia in middle-income countries: A systematic review and meta-analysis. Eur J Cancer 2013; 49:2555-64. [DOI: 10.1016/j.ejca.2013.03.024] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 03/02/2013] [Accepted: 03/19/2013] [Indexed: 11/30/2022]
|
31
|
Socioeconomic variation in survival from childhood leukaemia in northern England, 1968-2010. Br J Cancer 2013; 108:2339-45. [PMID: 23652301 PMCID: PMC3681006 DOI: 10.1038/bjc.2013.222] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Despite marked improvements in childhood leukaemia survival, 20% still die within 5 years of diagnosis. The aim of this study was to evaluate the relationship between socioeconomic status, as assessed by paternal occupation at birth, and survival from childhood leukaemia in children, using data from the Northern Region Young Persons Malignant Disease Registry. Methods: All 1007 cases of leukaemia in children aged 0–14 years, diagnosed between 1968 and 2010 and registered with the Registry were studied. Paternal occupational social class at the time of the child's birth was obtained and analysed in relation to survival using Cox-proportional regression. Results: Compared with the most advantaged group (I/II), those in the middle group (IIIN/M) had a 68% increased risk of death, while those in the least advantaged group (IV/V) had 86% higher risk for acute lymphoblastic leukaemia. While the survival advantage of children in class I/II was apparent from the time of diagnosis, survival for children in groups IIIN/M and IV/V were comparable until 3–4 years after diagnosis, when they began to minimally diverge. Conclusion: The existence of such socioeconomic disparities cannot be attributed to accessibility to health care in the United Kingdom. Further research into the likely factors underlying these disparities is required.
Collapse
|
32
|
Childhood leukemia and lymphoma: time trends and factors affecting survival in five Southern and Eastern European Cancer Registries. Cancer Causes Control 2013; 24:1111-8. [PMID: 23529470 DOI: 10.1007/s10552-013-0188-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 03/14/2013] [Indexed: 12/22/2022]
|
33
|
Gao YJ, Qian XW, Lu FJ, Zhai XW, Wang HS, Li J. Improved outcome for children with non-high risk acute lymphoblastic leukaemia after using an ALL IC-BFM 2002-based protocol in Shanghai, China. Br J Haematol 2012; 160:363-7. [PMID: 23151178 DOI: 10.1111/bjh.12122] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 09/20/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Yi-Jin Gao
- Children's Hospital; Shanghai Medical College; Fudan University; Shanghai; China
| | - Xiao-Wen Qian
- Children's Hospital; Shanghai Medical College; Fudan University; Shanghai; China
| | - Feng-Juan Lu
- Children's Hospital; Shanghai Medical College; Fudan University; Shanghai; China
| | - Xiao-Wen Zhai
- Children's Hospital; Shanghai Medical College; Fudan University; Shanghai; China
| | - Hong-Sheng Wang
- Children's Hospital; Shanghai Medical College; Fudan University; Shanghai; China
| | - Jun Li
- Children's Hospital; Shanghai Medical College; Fudan University; Shanghai; China
| |
Collapse
|
34
|
Xu XJ, Tang YM, Shen HQ, Song H, Yang SL, Shi SW, Xu WQ. Day 22 of induction therapy is important for minimal residual disease assessment by flow cytometry in childhood acute lymphoblastic leukemia. Leuk Res 2012; 36:1022-7. [DOI: 10.1016/j.leukres.2012.03.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 03/12/2012] [Accepted: 03/14/2012] [Indexed: 12/27/2022]
|
35
|
Lightfoot T, Johnston W, Simpson J, Smith A, Ansell P, Crouch S, Roman E, Kinsey S. Survival from childhood acute lymphoblastic leukaemia: the impact of social inequality in the United Kingdom. Eur J Cancer 2012; 48:263-9. [DOI: 10.1016/j.ejca.2011.10.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Revised: 10/04/2011] [Accepted: 10/10/2011] [Indexed: 11/26/2022]
|
36
|
Wang YR, Jin RM, Xu JW, Zhang ZQ. A report about treatment refusal and abandonment in children with acute lymphoblastic leukemia in China, 1997–2007. Leuk Res 2011; 35:1628-31. [DOI: 10.1016/j.leukres.2011.07.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 06/07/2011] [Accepted: 07/04/2011] [Indexed: 10/17/2022]
|
37
|
Ji Y, Chen S, Li K, Xiao N, Yang X, Zheng S, Xiao X. Measuring health-related quality of life in children with cancer living in Mainland China: feasibility, reliability and validity of the Chinese Mandarin version of PedsQL 4.0 Generic Core Scales and 3.0 Cancer Module. Health Qual Life Outcomes 2011; 9:103. [PMID: 22111968 PMCID: PMC3294248 DOI: 10.1186/1477-7525-9-103] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Accepted: 11/23/2011] [Indexed: 11/12/2022] Open
Abstract
Background The Pediatric Quality of Life Inventory (PedsQL) is widely used instrument to measure pediatric health-related quality of life (HRQOL) for children aged 2 to 18 years. The purpose of the current study was to investigate the feasibility, reliability and validity of the Chinese mandarin version of the PedsQL 4.0 Generic Core Scales and 3.0 Cancer Module in a group of Chinese children with cancer. Methods The PedsQL 4.0 Genetic Core Scales and the PedsQL 3.0 Cancer Module were administered to children with cancer (aged 5-18 years) and parents of such children (aged 2-18 years). For comparison, a survey on a demographically group-matched sample of the general population with children (aged 5-18) and parents of children (aged 2-18 years) was conducted with the PedsQL 4.0 Genetic Core Scales. Result The minimal mean percentage of missing item responses (except the School Functioning scale) supported the feasibility of the PedsQL 4.0 Generic Core Scales and 3.0 Cancer Module for Chinese children with cancer. Most of the scales showed satisfactory reliability with Cronbach's α of exceeding 0.70, and all scales demonstrated sufficient test-retest reliability. Assessing the clinical validity of the questionnaires, statistically significant difference was found between healthy children and children with cancer, and between children on-treatment versus off-treatment ≥12 months. Positive significant correlations were observed between the scores of the PedsQL 4.0 Generic Core Scale and the PedsQL 3.0 Cancer Module. Exploratory factor analysis demonstrated sufficient factorial validity. Moderate to good agreement was found between child self- and parent proxy-reports. Conclusion The findings support the feasibility, reliability and validity of the Chinese Mandarin version of PedsQL 4.0 Generic Core Scales and 3.0 Cancer Module in children with cancer living in mainland China.
Collapse
Affiliation(s)
- Yi Ji
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai 201102, China
| | | | | | | | | | | | | |
Collapse
|
38
|
Etiology of septicemia in children with acute leukemia: 9-year experience from a children's hospital in China. J Pediatr Hematol Oncol 2011; 33:e186-91. [PMID: 21617561 DOI: 10.1097/mph.0b013e31821ba92c] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Bloodstream infection is an important cause of death among leukemia patients, and the etiologic agent surveillance is important for the prophylaxis and treatment. This study aims to identify the common bloodstream isolates in hospitalized leukemia patients with septicemia in our hospital, to choose the ideal combination of antimicrobial agents for infection prophylaxis and to clarify the appropriate time for antibiotic prophylaxis. To know this information, a retrospective analysis was conducted over a 9-year period from July 2001 to July 2010 by reviewing medical records of leukemia children admitted to our hospital. The overall frequencies of isolation were 45% in Gram-positive bacteria, 53.8% in Gram-negative bacteria, and 1.2% in fungi, respectively. Coagulase-negative Staphylococci were the most common organisms isolated, accounting for 32.7% of the total blood culture isolates, followed by Escherichia coli (15.7%) and Klebsiella pneumoniae (7.1%). The incidence of septicemia caused by extended-spectrum β-lactamase-producing E. coli and K. pneumoniae was high (69.2% and 58.8% of total isolates, respectively). The coverage rate of antimicrobial combinations of "vancomycin+cefoperazone-sulbactam" and "vancomycin+piperacillin-tazobactam" to blood culture isolates of leukemia patients in our hospital were 91.88% and 90.27%, respectively. More than 90% of septicemia occurred when the absolute neutrophil count was lower than 1.6×10⁹/L and 83.05% when absolute neutrophil count was lower than 1.0×10⁹/L. These results suggest that ongoing surveillance for antimicrobial susceptibility in leukemia children remains essential. Vancomycin+cefoperazone-sulbactam and vancomycin+piperacillin-tazobactam are the good choice for leukemia children to prevent bacterial infections in our hospital. In an effort to reduce total consumption of antibiotics and to elevate the therapeutic efficacy, antibiotics prophylaxis should be started with the appearance of neutropenia in leukemia children.
Collapse
|
39
|
Gupta S, Antillon FA, Bonilla M, Fu L, Howard SC, Ribeiro RC, Sung L. Treatment-related mortality in children with acute lymphoblastic leukemia in Central America. Cancer 2011; 117:4788-95. [DOI: 10.1002/cncr.26107] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Revised: 02/11/2011] [Accepted: 02/14/2011] [Indexed: 11/10/2022]
|
40
|
Bonilla M, Gupta S, Vasquez R, Fuentes SL, deReyes G, Ribeiro R, Sung L. Predictors of outcome and methodological issues in children with acute lymphoblastic leukaemia in El Salvador. Eur J Cancer 2010; 46:3280-6. [DOI: 10.1016/j.ejca.2010.07.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Revised: 06/22/2010] [Accepted: 07/01/2010] [Indexed: 10/19/2022]
|
41
|
Xu XJ, Tang YM, Song H, Yang SL, Shi SW, Wei J. Long-term outcome of childhood acute myeloid leukemia in a developing country: experience from a children's hospital in China. Leuk Lymphoma 2010; 51:2262-9. [DOI: 10.3109/10428194.2010.518653] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
42
|
Abstract
In 538 febrile episodes in 188 children enrolled prospectively, 62% of children were neutropenic and 86% had infection-related fever. Respiratory infection was the commonest febrile cause (60%). Bacteremia occurred more often in neutropenic than non-neutropenic episodes (20% vs. 3%) and was accompanied significantly more with shiver, lassitude, and decreased dorsum pedis pulse. About 65% of blood isolates were Gram-negative bacilli, which differs from the observations in western countries.
Collapse
|
43
|
Kong KA, Khang YH, Cha ES, Moon EK, Lee YH, Lee WJ. Childhood cancer mortality and socioeconomic position in South Korea: a national population-based birth cohort study. Cancer Causes Control 2010; 21:1559-67. [PMID: 20512527 DOI: 10.1007/s10552-010-9584-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Accepted: 05/13/2010] [Indexed: 10/19/2022]
|
44
|
Brandalise SR, Pinheiro VR, Aguiar SS, Matsuda EI, Otubo R, Yunes JA, Pereira WV, Carvalho EG, Cristofani LM, Souza MS, Lee ML, Dobbin JA, Pombo-de-Oliveira MS, Lopes LF, Melnikoff KN, Brunetto AL, Tone LG, Scrideli CA, Morais VL, Viana MB. Benefits of the Intermittent Use of 6-Mercaptopurine and Methotrexate in Maintenance Treatment for Low-Risk Acute Lymphoblastic Leukemia in Children: Randomized Trial From the Brazilian Childhood Cooperative Group—Protocol ALL-99. J Clin Oncol 2010; 28:1911-8. [DOI: 10.1200/jco.2009.25.6115] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PurposeTo describe event-free survival (EFS) and toxicities in children with low-risk acute lymphoblastic leukemia (ALL) assigned to receive either continuous 6-mercaptopurine (6-MP) and weekly methotrexate (MTX) or intermittent 6-MP with intermediate-dose MTX, as maintenance treatment.Patients and MethodsBetween October 1, 2000, and December 31, 2007, 635 patients with low-risk ALL were enrolled onto Brazilian Childhood Cooperative Group for ALL Treatment (GBTLI) ALL-99 protocol. Eligible children (n = 544) were randomly allocated to receive either continuous 6-MP/MTX (group 1, n = 272) or intermittent 6-MP (100 mg/m2/d for 10 days, with 11 days resting) and MTX (200 mg/m2every 3 weeks; group 2, n = 272).ResultsThe 5-year overall survival (OS) and EFS were 92.5% ± 1.5% SE and 83.6% ± 2.1% SE, respectively. According to maintenance regimen, the OS was 91.4% ± 2.2% SE (group 1) and 93.6% ± 2.1% SE (group 2; P = .28) and EFS 80.9% ± 3.2% SE (group 1) and 86.5% ± 2.8% SE (group 2; P = .089). Remarkably, the intermittent regimen led to significantly higher EFS among boys (85.7% v 74.9% SE; P = .027), while no difference was seen for girls (87.0% v 88.8% SE; P = .78). Toxic episodes were recorded in 226 and 237 children, respectively. Grade 3 to 4 toxic events for groups 1 and 2 were, respectively, 273 and 166 for hepatic dysfunction (P = .002), and 772 and 636 for hematologic episodes (P = .005). Deaths on maintenance were: seven (group 1) and one (group 2).ConclusionThe intermittent use of 6-MP and MTX in maintenance is a less toxic regimen, with a trend toward better long-term EFS. Boys treated with the intermittent schedule had significantly better EFS.
Collapse
Affiliation(s)
- Silvia R. Brandalise
- From the Serviço de Hematologia/Oncologia Pediátrica, Universidade Estadual de Campinas; Centro Infantil Boldrini, Campinas; Instituto da Criança, Universidade de São Paulo; Grupo de Apoio à Criança com Câncer; Hospital A.C. Camargo; Hospital Brigadeiro; Hospital das Clinicas, Ribeirão Preto, São Paulo; Hospital Universitário, Santa Maria; Instituto de Oncologia, Salvador; Hospital Regional, Campo Grande; Instituto Nacional do Câncer, Rio de Janeiro; Hospital das Clinicas, Porto Alegre; Hospital Oswaldo
| | - Vitória R. Pinheiro
- From the Serviço de Hematologia/Oncologia Pediátrica, Universidade Estadual de Campinas; Centro Infantil Boldrini, Campinas; Instituto da Criança, Universidade de São Paulo; Grupo de Apoio à Criança com Câncer; Hospital A.C. Camargo; Hospital Brigadeiro; Hospital das Clinicas, Ribeirão Preto, São Paulo; Hospital Universitário, Santa Maria; Instituto de Oncologia, Salvador; Hospital Regional, Campo Grande; Instituto Nacional do Câncer, Rio de Janeiro; Hospital das Clinicas, Porto Alegre; Hospital Oswaldo
| | - Simone S. Aguiar
- From the Serviço de Hematologia/Oncologia Pediátrica, Universidade Estadual de Campinas; Centro Infantil Boldrini, Campinas; Instituto da Criança, Universidade de São Paulo; Grupo de Apoio à Criança com Câncer; Hospital A.C. Camargo; Hospital Brigadeiro; Hospital das Clinicas, Ribeirão Preto, São Paulo; Hospital Universitário, Santa Maria; Instituto de Oncologia, Salvador; Hospital Regional, Campo Grande; Instituto Nacional do Câncer, Rio de Janeiro; Hospital das Clinicas, Porto Alegre; Hospital Oswaldo
| | - Eduardo I. Matsuda
- From the Serviço de Hematologia/Oncologia Pediátrica, Universidade Estadual de Campinas; Centro Infantil Boldrini, Campinas; Instituto da Criança, Universidade de São Paulo; Grupo de Apoio à Criança com Câncer; Hospital A.C. Camargo; Hospital Brigadeiro; Hospital das Clinicas, Ribeirão Preto, São Paulo; Hospital Universitário, Santa Maria; Instituto de Oncologia, Salvador; Hospital Regional, Campo Grande; Instituto Nacional do Câncer, Rio de Janeiro; Hospital das Clinicas, Porto Alegre; Hospital Oswaldo
| | - Rosemary Otubo
- From the Serviço de Hematologia/Oncologia Pediátrica, Universidade Estadual de Campinas; Centro Infantil Boldrini, Campinas; Instituto da Criança, Universidade de São Paulo; Grupo de Apoio à Criança com Câncer; Hospital A.C. Camargo; Hospital Brigadeiro; Hospital das Clinicas, Ribeirão Preto, São Paulo; Hospital Universitário, Santa Maria; Instituto de Oncologia, Salvador; Hospital Regional, Campo Grande; Instituto Nacional do Câncer, Rio de Janeiro; Hospital das Clinicas, Porto Alegre; Hospital Oswaldo
| | - José A. Yunes
- From the Serviço de Hematologia/Oncologia Pediátrica, Universidade Estadual de Campinas; Centro Infantil Boldrini, Campinas; Instituto da Criança, Universidade de São Paulo; Grupo de Apoio à Criança com Câncer; Hospital A.C. Camargo; Hospital Brigadeiro; Hospital das Clinicas, Ribeirão Preto, São Paulo; Hospital Universitário, Santa Maria; Instituto de Oncologia, Salvador; Hospital Regional, Campo Grande; Instituto Nacional do Câncer, Rio de Janeiro; Hospital das Clinicas, Porto Alegre; Hospital Oswaldo
| | - Waldir V. Pereira
- From the Serviço de Hematologia/Oncologia Pediátrica, Universidade Estadual de Campinas; Centro Infantil Boldrini, Campinas; Instituto da Criança, Universidade de São Paulo; Grupo de Apoio à Criança com Câncer; Hospital A.C. Camargo; Hospital Brigadeiro; Hospital das Clinicas, Ribeirão Preto, São Paulo; Hospital Universitário, Santa Maria; Instituto de Oncologia, Salvador; Hospital Regional, Campo Grande; Instituto Nacional do Câncer, Rio de Janeiro; Hospital das Clinicas, Porto Alegre; Hospital Oswaldo
| | - Eny G. Carvalho
- From the Serviço de Hematologia/Oncologia Pediátrica, Universidade Estadual de Campinas; Centro Infantil Boldrini, Campinas; Instituto da Criança, Universidade de São Paulo; Grupo de Apoio à Criança com Câncer; Hospital A.C. Camargo; Hospital Brigadeiro; Hospital das Clinicas, Ribeirão Preto, São Paulo; Hospital Universitário, Santa Maria; Instituto de Oncologia, Salvador; Hospital Regional, Campo Grande; Instituto Nacional do Câncer, Rio de Janeiro; Hospital das Clinicas, Porto Alegre; Hospital Oswaldo
| | - Lilian M. Cristofani
- From the Serviço de Hematologia/Oncologia Pediátrica, Universidade Estadual de Campinas; Centro Infantil Boldrini, Campinas; Instituto da Criança, Universidade de São Paulo; Grupo de Apoio à Criança com Câncer; Hospital A.C. Camargo; Hospital Brigadeiro; Hospital das Clinicas, Ribeirão Preto, São Paulo; Hospital Universitário, Santa Maria; Instituto de Oncologia, Salvador; Hospital Regional, Campo Grande; Instituto Nacional do Câncer, Rio de Janeiro; Hospital das Clinicas, Porto Alegre; Hospital Oswaldo
| | - Marcelo S. Souza
- From the Serviço de Hematologia/Oncologia Pediátrica, Universidade Estadual de Campinas; Centro Infantil Boldrini, Campinas; Instituto da Criança, Universidade de São Paulo; Grupo de Apoio à Criança com Câncer; Hospital A.C. Camargo; Hospital Brigadeiro; Hospital das Clinicas, Ribeirão Preto, São Paulo; Hospital Universitário, Santa Maria; Instituto de Oncologia, Salvador; Hospital Regional, Campo Grande; Instituto Nacional do Câncer, Rio de Janeiro; Hospital das Clinicas, Porto Alegre; Hospital Oswaldo
| | - Maria L. Lee
- From the Serviço de Hematologia/Oncologia Pediátrica, Universidade Estadual de Campinas; Centro Infantil Boldrini, Campinas; Instituto da Criança, Universidade de São Paulo; Grupo de Apoio à Criança com Câncer; Hospital A.C. Camargo; Hospital Brigadeiro; Hospital das Clinicas, Ribeirão Preto, São Paulo; Hospital Universitário, Santa Maria; Instituto de Oncologia, Salvador; Hospital Regional, Campo Grande; Instituto Nacional do Câncer, Rio de Janeiro; Hospital das Clinicas, Porto Alegre; Hospital Oswaldo
| | - Jane A. Dobbin
- From the Serviço de Hematologia/Oncologia Pediátrica, Universidade Estadual de Campinas; Centro Infantil Boldrini, Campinas; Instituto da Criança, Universidade de São Paulo; Grupo de Apoio à Criança com Câncer; Hospital A.C. Camargo; Hospital Brigadeiro; Hospital das Clinicas, Ribeirão Preto, São Paulo; Hospital Universitário, Santa Maria; Instituto de Oncologia, Salvador; Hospital Regional, Campo Grande; Instituto Nacional do Câncer, Rio de Janeiro; Hospital das Clinicas, Porto Alegre; Hospital Oswaldo
| | - Maria S. Pombo-de-Oliveira
- From the Serviço de Hematologia/Oncologia Pediátrica, Universidade Estadual de Campinas; Centro Infantil Boldrini, Campinas; Instituto da Criança, Universidade de São Paulo; Grupo de Apoio à Criança com Câncer; Hospital A.C. Camargo; Hospital Brigadeiro; Hospital das Clinicas, Ribeirão Preto, São Paulo; Hospital Universitário, Santa Maria; Instituto de Oncologia, Salvador; Hospital Regional, Campo Grande; Instituto Nacional do Câncer, Rio de Janeiro; Hospital das Clinicas, Porto Alegre; Hospital Oswaldo
| | - Luiz F. Lopes
- From the Serviço de Hematologia/Oncologia Pediátrica, Universidade Estadual de Campinas; Centro Infantil Boldrini, Campinas; Instituto da Criança, Universidade de São Paulo; Grupo de Apoio à Criança com Câncer; Hospital A.C. Camargo; Hospital Brigadeiro; Hospital das Clinicas, Ribeirão Preto, São Paulo; Hospital Universitário, Santa Maria; Instituto de Oncologia, Salvador; Hospital Regional, Campo Grande; Instituto Nacional do Câncer, Rio de Janeiro; Hospital das Clinicas, Porto Alegre; Hospital Oswaldo
| | - Katharina N.T. Melnikoff
- From the Serviço de Hematologia/Oncologia Pediátrica, Universidade Estadual de Campinas; Centro Infantil Boldrini, Campinas; Instituto da Criança, Universidade de São Paulo; Grupo de Apoio à Criança com Câncer; Hospital A.C. Camargo; Hospital Brigadeiro; Hospital das Clinicas, Ribeirão Preto, São Paulo; Hospital Universitário, Santa Maria; Instituto de Oncologia, Salvador; Hospital Regional, Campo Grande; Instituto Nacional do Câncer, Rio de Janeiro; Hospital das Clinicas, Porto Alegre; Hospital Oswaldo
| | - Algemir L. Brunetto
- From the Serviço de Hematologia/Oncologia Pediátrica, Universidade Estadual de Campinas; Centro Infantil Boldrini, Campinas; Instituto da Criança, Universidade de São Paulo; Grupo de Apoio à Criança com Câncer; Hospital A.C. Camargo; Hospital Brigadeiro; Hospital das Clinicas, Ribeirão Preto, São Paulo; Hospital Universitário, Santa Maria; Instituto de Oncologia, Salvador; Hospital Regional, Campo Grande; Instituto Nacional do Câncer, Rio de Janeiro; Hospital das Clinicas, Porto Alegre; Hospital Oswaldo
| | - Luiz G. Tone
- From the Serviço de Hematologia/Oncologia Pediátrica, Universidade Estadual de Campinas; Centro Infantil Boldrini, Campinas; Instituto da Criança, Universidade de São Paulo; Grupo de Apoio à Criança com Câncer; Hospital A.C. Camargo; Hospital Brigadeiro; Hospital das Clinicas, Ribeirão Preto, São Paulo; Hospital Universitário, Santa Maria; Instituto de Oncologia, Salvador; Hospital Regional, Campo Grande; Instituto Nacional do Câncer, Rio de Janeiro; Hospital das Clinicas, Porto Alegre; Hospital Oswaldo
| | - Carlos A. Scrideli
- From the Serviço de Hematologia/Oncologia Pediátrica, Universidade Estadual de Campinas; Centro Infantil Boldrini, Campinas; Instituto da Criança, Universidade de São Paulo; Grupo de Apoio à Criança com Câncer; Hospital A.C. Camargo; Hospital Brigadeiro; Hospital das Clinicas, Ribeirão Preto, São Paulo; Hospital Universitário, Santa Maria; Instituto de Oncologia, Salvador; Hospital Regional, Campo Grande; Instituto Nacional do Câncer, Rio de Janeiro; Hospital das Clinicas, Porto Alegre; Hospital Oswaldo
| | - Vera L.L. Morais
- From the Serviço de Hematologia/Oncologia Pediátrica, Universidade Estadual de Campinas; Centro Infantil Boldrini, Campinas; Instituto da Criança, Universidade de São Paulo; Grupo de Apoio à Criança com Câncer; Hospital A.C. Camargo; Hospital Brigadeiro; Hospital das Clinicas, Ribeirão Preto, São Paulo; Hospital Universitário, Santa Maria; Instituto de Oncologia, Salvador; Hospital Regional, Campo Grande; Instituto Nacional do Câncer, Rio de Janeiro; Hospital das Clinicas, Porto Alegre; Hospital Oswaldo
| | - Marcos B. Viana
- From the Serviço de Hematologia/Oncologia Pediátrica, Universidade Estadual de Campinas; Centro Infantil Boldrini, Campinas; Instituto da Criança, Universidade de São Paulo; Grupo de Apoio à Criança com Câncer; Hospital A.C. Camargo; Hospital Brigadeiro; Hospital das Clinicas, Ribeirão Preto, São Paulo; Hospital Universitário, Santa Maria; Instituto de Oncologia, Salvador; Hospital Regional, Campo Grande; Instituto Nacional do Câncer, Rio de Janeiro; Hospital das Clinicas, Porto Alegre; Hospital Oswaldo
| |
Collapse
|
45
|
Liu Y, Chen J, Tang J, Ni S, Xue H, Pan C. Cost of childhood acute lymphoblastic leukemia care in Shanghai, China. Pediatr Blood Cancer 2009; 53:557-62. [PMID: 19526524 DOI: 10.1002/pbc.22127] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Acute lymphoblastic leukemia (ALL) is the most common and curable malignant pediatric disease in children. In low- and middle-income countries, however, economic factors prevent many patients from receiving complete treatment, even as government and insurance entities lack complete data on the costs for ALL therapies. Here, we analyzed the overall costs for pediatric ALL therapies and their constitutive elements. PROCEDURE All cost information was drawn from our hospital database. We analyzed the costs of 45 newly diagnosed children with ALL from May 2005 to June 2006; 20 were classified into low-risk group, 25 into medium-risk group, and all had completed the ALL-2005 protocol treatment. Forty cases were B-lineage, four were T-lineage, and one was double-lymphoid lineage. RESULTS Average total clinic expense per person was US $3,694.58 +/- 1,376.85. Average total in-hospital expense per patient was US $7,299.48 +/- 6,526.39, with a large individual difference. Medicine and laboratory test costs represented 40.5% and 21.5%, respectively. Patients stayed at home or attended clinic for more than 90% of the therapy period. In-hospital and clinic constituted 66.4% and 33.6% of costs, respectively. Costs among risk groups and with/without severe complications differed significantly (P < 0.05). Thirty-month event-free survivals were 94.14% and 82.81% for the low- and medium-risk groups, respectively. CONCLUSION Risk group and severe complications were main factors affecting total medical costs. Average overall costs for childhood ALL in this study were less than US $11,000, with reasonable clinical results.
Collapse
Affiliation(s)
- Yin Liu
- Department of Hematology/Oncology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | | | | | | | | | | |
Collapse
|
46
|
Luo XQ, Ke ZY, Huang LB, Guan XQ, Zhang YC, Zhang XL. Improved outcome for Chinese children with acute promyelocytic leukemia: a comparison of two protocols. Pediatr Blood Cancer 2009; 53:325-8. [PMID: 19422024 DOI: 10.1002/pbc.22042] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Acute promyelocytic leukemia (APL) is now highly curable, except in many developing countries. Introduction of current treatment strategies may improve the outcome for children with APL in these countries. METHODS The diagnosis was based on the FAB classification and detection of PML-RAR alpha rearrangement. From December 1999 to September 2004, 16 eligible children were treated with an intensive in-house protocol including high-dose AraC and anthracycline. Subsequently, 14 cases were treated with a less intensive protocol modified from the PETHEMA LPA99. RESULTS The 3.5 years event-free survival (EFS) was 37.5% (95% CI, 13.8-61.2%) for patients treated on initial protocol. The treatment failures were: six patients abandoned treatment (37.5%), two who died of intracranial hemorrhage at diagnosis (6.3%) and sepsis in remission (6.3%) respectively, and two who relapsed (12.5%). Those treated on modified PETHEMA had a 3.5 years EFS of 79.6% (95% CI, 52.9-106.3%). Treatment failures included: one who died of intracranial hemorrhage at diagnosis (7.1%) and one who relapsed (7.1%). The patients on modified PETHEMA had a significantly higher EFS (P = 0.012), lower frequency of sepsis during treatment (7.7% vs. 77.8%; P = 0.0015), and lower hospitalization cost (median US$ 4,700 vs. US$ 20,000; P < 0.0001) than those on in-house protocol. CONCLUSION Treatment with the less intensive protocol based on the PETHEMA LPA99 study of childhood APL successfully reduced chemotherapy toxicity and lowered hospitalization costs without increasing relapses. This led to decreases in treatment-related morbidity and the treatment abandonment rate, thus improving overall outcome.
Collapse
Affiliation(s)
- Xue-Qun Luo
- Department of Pediatric, The First Affiliated Hospital of Sun Yat-Sen University, Zhongshan Er Lu, Guangzhou, China.
| | | | | | | | | | | |
Collapse
|