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Tabassum N, Muhammad S, Mirza T, Butt Z, Mansoor N. Clinical Characteristics and Cytogenetics of Childhood Acute Lymphoblastic Leukemia in a Single Center in Pakistan. Glob Pediatr Health 2024; 11:2333794X241256863. [PMID: 39070153 PMCID: PMC11283658 DOI: 10.1177/2333794x241256863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 04/18/2024] [Accepted: 05/07/2024] [Indexed: 07/30/2024] Open
Abstract
Objectives. This study aimed to find the association between clinical characteristics, cytogenetics, and post-induction outcomes of childhood acute lymphoblastic leukemia. Methods. The study was conducted at the Indus Hospital in Karachi. Initial total leukocyte count (TLC), cytogenetics, CNS status, and post-induction remission status were recorded. Results. Out of 108 children diagnosed with ALL, 66 (61.1%) were male and 42 (38.9%) were female. The majority 90 (83.3%) had B-ALL. CNS1 status was observed in 76 (84.4%) B-ALL and 18 (88.9%) T-ALL. All T-ALL and 89 (98.8%) B-ALL achieved remission post-induction. In B-ALL, 50 (55.5%) had a normal diploid karyotype, and 22 (24.4%) had numerical abnormalities. No typical gene rearrangement was observed in 66 (73.3%), 11 (12.2%) had BCR::ABL1, 10 (11.1%) had ETV6::RUNX1 and 3 (3.3%) KMT2A on FISH. No significant difference was observed between cytogenetics and clinical characteristics (P > .05). Conclusion. The study provides valuable data on childhood acute lymphoblastic leukemia in the Pakistani population.
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Sampagar A, Patil NG, Reddy NA, Dias M. ALL induction outcome: Real-world data from a pediatric oncology center in an LMIC setup with rural predominance. Indian J Cancer 2024; 61:215-223. [PMID: 38217488 DOI: 10.4103/ijc.ijc_355_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/14/2021] [Indexed: 01/15/2024]
Abstract
BACKGROUND Acute lymphoblastic leukemia (ALL) has survival rates of greater than 90% in developed nations. However, various sociodemographic factors adversely affect outcome rates in low- and middle-income countries (LMICs). OBJECTIVE To study induction outcome of ALL and various factors affecting it. METHODS This was a prospective cohort study which enrolled 86 children up to the age of 18 years with newly diagnosed ALL registered in newly established pediatric hematology and oncology division over the duration of 3 years. Sociodemographic and clinical data was collected. Outcome was assessed using morphological remission, minimal residual disease (MRD) and mortality rate. RESULTS Of the 170 children with malignancies registered, 86 were ALL. Mean age was 7.09 ± 4.07 years and the M: F ratio of 1.32:1. Sixteen (38.09%) of them had severe acute malnutrition and another 16 (38.09%) had moderate acute malnutrition. Thirty (68.18%) children over 5 years were undernourished. Seventy-four (86.05%) were B-ALL and 12 (13.95%) T-ALL. In total, 28.77% had WBC counts greater than 50 × 10 9 /L. t (12;21) was the most common cytogenetic abnormality. Majority (60.46%) of the patients belonged to lower socioeconomic status. Seventy-one (93.42%) patients completed induction of which 100% attained morphological remission and 64 (90.14%) were MRD negative. There were five mortalities, three (60%) due to sepsis and 2 (40%) due to hemophagocytic lymphohistiocytosis. Fifty (65.78%) children had morbidities during induction, febrile neutropenia being the commonest. CONCLUSIONS Successful induction outcome rates at par with high-income countries can be achieved even in resource-limited settings of LMIC with support from government and NGOs. Decentralized cancer care centers can effectively pave the way in reducing cancer mortality in children of lower socioeconomic status residing in rural areas.
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Affiliation(s)
- Abhilasha Sampagar
- Department of Paediatrics, KAHER's Jawaharlal Nehru Medical College, Nehru Nagar, Belagavi, Karnataka, India
- Paediatric Hematology and Oncology Division, KLES Dr. Prabhakar Kore Hospital and MRC, Belagavi, Karnataka, India
| | - Neha G Patil
- Department of Paediatrics, KAHER's Jawaharlal Nehru Medical College, Nehru Nagar, Belagavi, Karnataka, India
| | - Nalla A Reddy
- Department of Paediatrics, KAHER's Jawaharlal Nehru Medical College, Nehru Nagar, Belagavi, Karnataka, India
| | - Merle Dias
- Department of Paediatrics, KAHER's Jawaharlal Nehru Medical College, Nehru Nagar, Belagavi, Karnataka, India
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Gándara-Mireles JA, Lares-Asseff I, Reyes Espinoza EA, Fierro IV, Castañeda VL, Cordova Hurtado LP, González CD, Romero LP, Reyes HA. Impact of single-nucleotide variants and nutritional status on population pharmacokinetics of Doxorubicin, and its effect on cardiotoxicity in children with leukemia. J Oncol Pharm Pract 2023; 29:1290-1305. [PMID: 36113156 DOI: 10.1177/10781552221117810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
PURPOSE Doxorubicin is an important antineoplastic agent with wide interindividual variability in response to treatment and in its cardiotoxic effects. To determine the effect of genotypic status of three single-nucleotide variants in ABCC1, NCF4, and CBR3 genes and nutritional status assessed by body mass index, on the population pharmacokinetics of Doxorubicin and its cardiotoxic effects in pediatric patients with leukemia. PATIENTS AND METHODS Seventy pediatric patients treated with Doxorubicin were studied, in which 189 biological samples were obtained to determine Doxorubicin concentrations (1 to 3 samples per patient) at different times, for 20 h. RESULTS Low body mass index and age ≤ 7 years were associated with decreased clearance of Doxorubicin, and female gender was associated with increased clearance of Doxorubicin. Low BMI and low height were associated with a decrease and increase, respectively, in the intercompartmental clearance (Q) of Doxorubicin. TT homozygosity of the single-nucleotide variant rs3743527 of the ABCC1 gene was associated with an increase in clearance and decreased area under the curve, AA homozygosity of the single-nucleotide variant rs1883112 of the NCF4 gene was associated with a decrease in the volume of distribution in the peripheral compartment (V2), and GG homozygosity of CBR3 rs1056892 with increasing area under the curve. CONCLUSION Some covariates studied are directly related to the increase or decrease of the pharmacokinetic parameters of Doxorubicin. Decreased clearance, V2, and increased area under the curve were associated with systolic dysfunction, and decreased Q and V2 were associated with diastolic dysfunction. These results may contribute to the effective and safe use of Doxorubicin in pediatric patients with leukemia.
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Affiliation(s)
- Jesús Alonso Gándara-Mireles
- Academia de Genómica/Instituto Politécnico Nacional, CIIDIR-Unidad Durango, Dgo., México
- Red Latinoamericana de Implementación y Validación de Guías Clínicas Farmacogenómicas (RELIVAF-CYTED), Santiago, Chile
| | - Ismael Lares-Asseff
- Academia de Genómica/Instituto Politécnico Nacional, CIIDIR-Unidad Durango, Dgo., México
- Red Latinoamericana de Implementación y Validación de Guías Clínicas Farmacogenómicas (RELIVAF-CYTED), Santiago, Chile
| | | | - Ignacio Villanueva Fierro
- Academia de Genómica/Instituto Politécnico Nacional, CIIDIR-Unidad Durango, Dgo., México
- Red Latinoamericana de Implementación y Validación de Guías Clínicas Farmacogenómicas (RELIVAF-CYTED), Santiago, Chile
| | - Verónica Loera Castañeda
- Academia de Genómica/Instituto Politécnico Nacional, CIIDIR-Unidad Durango, Dgo., México
- Red Latinoamericana de Implementación y Validación de Guías Clínicas Farmacogenómicas (RELIVAF-CYTED), Santiago, Chile
| | | | - Carla Díaz González
- Servicio de Onco-Hematología Pediátrica/Centro Estatal de Cancerología, CECAN Durango, Dgo., México
| | - Leslie Patrón Romero
- Facultad de Medicina y Psicología/Universidad Autónoma de Baja California, TJ, México
| | - Horacio Almanza Reyes
- Red Latinoamericana de Implementación y Validación de Guías Clínicas Farmacogenómicas (RELIVAF-CYTED), Santiago, Chile
- Facultad de Medicina y Psicología/Universidad Autónoma de Baja California, TJ, México
- Universidad Tecnológica de Tijuana, TJ, México
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Ahmad I, Ghafoor T, Ullah A, Naz S, Tahir M, Ahmed S, Arshad A, Ali A, Khattack TA, Batool F. Pediatric Acute Lymphoblastic Leukemia: Clinical Characteristics, Treatment Outcomes, and Prognostic Factors: 10 Years' Experience From a Low- and Middle-Income Country. JCO Glob Oncol 2023; 9:e2200288. [PMID: 37290024 PMCID: PMC10497281 DOI: 10.1200/go.22.00288] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 03/06/2023] [Accepted: 04/03/2023] [Indexed: 06/10/2023] Open
Abstract
PURPOSE Acute lymphoblastic leukemia (ALL) represents around 70% of pediatric leukemia. In high-income countries, the 5-year survival is above 90%, but survival in low- and middle-income countries is inferior. This study documents the treatment outcome and prognostic factors of pediatric ALL in Pakistan. MATERIALS AND METHODS In this prospective cohort study, all newly diagnosed patients with ALL/lymphoblastic lymphoma from age 1 to 16 years enrolled between January 1, 2012, and December 31, 2021, were included. The treatment was based on the standard arm of the UKALL2011 protocol. RESULTS Data from 945 patients with ALL, including 597 males (63.2%), were analyzed. The mean age at diagnosis was 5.73 ± 3.51 years. Pallor was the commonest presentation in 95.2% followed by fever in 84.2% of patients. The mean WBC count was 56.6 ± 103.4 × 109/L. Neutropenic fever followed by myopathy was the most common complication during induction. In univariate analysis, the high WBC count (P ≤ 0.001), intensive chemotherapy (P ≤ 0.001), malnutrition (P = .007), poor response to induction chemotherapy (P = .001), delayed presentation (P = .004), and use of steroids before chemotherapy (P = .023) significantly adversely affected overall survival (OS). The delayed presentation was the most significant prognostic factor in the multivariate analysis (P ≤ .002). After a median follow-up of 54.64 ± 33.80 months, the 5-year OS and disease-free survival (DFS) were 69.9% and 67.8%, respectively. CONCLUSION In this largest cohort of childhood ALL from Pakistan, a high WBC count, malnutrition, delayed presentation, previous steroids use, intensive chemotherapy, and poor response to the induction chemotherapy were associated with decreased OS and DFS rates.
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Affiliation(s)
- Ishfaq Ahmad
- Department of Paediatric Oncology, Combined Military Hospital, Rawalpindi, Pakistan
| | - Tariq Ghafoor
- Department of Paediatric Oncology, Combined Military Hospital, Rawalpindi, Pakistan
- Armed Forces Bone Marrow Transplant Centre, CMH Medical Complex, Rawalpindi, Pakistan
| | - Anwar Ullah
- Department of Paediatric Oncology, Combined Military Hospital, Rawalpindi, Pakistan
| | - Shaista Naz
- Department of Paediatric Oncology, Combined Military Hospital, Rawalpindi, Pakistan
| | - Muhammad Tahir
- Department of Paediatric Oncology, Combined Military Hospital, Rawalpindi, Pakistan
| | - Shakeel Ahmed
- Department of Paediatric Oncology, Combined Military Hospital, Rawalpindi, Pakistan
| | - Awais Arshad
- Department of Paediatric Oncology, Combined Military Hospital, Rawalpindi, Pakistan
| | - Asghar Ali
- Armed Forces Bone Marrow Transplant Centre, CMH Medical Complex, Rawalpindi, Pakistan
| | - Tariq Azam Khattack
- Armed Forces Bone Marrow Transplant Centre, CMH Medical Complex, Rawalpindi, Pakistan
| | - Fatima Batool
- Islamabad Medical and Dental College, Islamabad, Pakistan
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Panuciak K, Nowicka E, Mastalerczyk A, Zawitkowska J, Niedźwiecki M, Lejman M. Overview on Aneuploidy in Childhood B-Cell Acute Lymphoblastic Leukemia. Int J Mol Sci 2023; 24:ijms24108764. [PMID: 37240110 DOI: 10.3390/ijms24108764] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/04/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Recent years have brought significant progress in the treatment of B-cell acute lymphoblastic leukemia (ALL). This was influenced by both the improved schemes of conventionally used therapy, as well as the development of new forms of treatment. As a consequence, 5-year survival rates have increased and now exceed 90% in pediatric patients. For this reason, it would seem that everything has already been explored in the context of ALL. However, delving into its pathogenesis at the molecular level shows that there are many variations that still need to be analyzed in more detail. One of them is aneuploidy, which is among the most common genetic changes in B-cell ALL. It includes both hyperdiploidy and hypodiploidy. Knowledge of the genetic background is important already at the time of diagnosis, because the first of these forms of aneuploidy is characterized by a good prognosis, in contrast to the second, which is in favor of an unfavorable course. In our work, we will focus on summarizing the current state of knowledge on aneuploidy, along with an indication of all the consequences that may be correlated with it in the context of the treatment of patients with B-cell ALL.
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Affiliation(s)
- Kinga Panuciak
- Student Scientific Society, Independent Laboratory of Genetic Diagnostics, Medical University of Lublin, 20-093 Lublin, Poland
| | - Emilia Nowicka
- Student Scientific Society, Independent Laboratory of Genetic Diagnostics, Medical University of Lublin, 20-093 Lublin, Poland
| | - Angelika Mastalerczyk
- Student Scientific Society, Independent Laboratory of Genetic Diagnostics, Medical University of Lublin, 20-093 Lublin, Poland
| | - Joanna Zawitkowska
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, Gębali 6, 20-093 Lublin, Poland
| | - Maciej Niedźwiecki
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, Debinki 7, 80-211 Gdansk, Poland
| | - Monika Lejman
- Independent Laboratory of Genetic Diagnostics, Medical University of Lublin, 20-093 Lublin, Poland
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Nisar I, Shahid S, Yousuf F, Lakhani LS, Ashraf S, Imam U, Zaheer J, Belgaumi A, Fadoo Z. Treatment outcomes and prognostic factors of childhood acute lymphoblastic leukemia in a low-middle income population: A multi-institutional report from Pakistan. Pediatr Blood Cancer 2023; 70:e29889. [PMID: 35920528 DOI: 10.1002/pbc.29889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 06/27/2022] [Accepted: 06/27/2022] [Indexed: 01/09/2023]
Affiliation(s)
- Imran Nisar
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Shahira Shahid
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Fatimah Yousuf
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Laila Saleem Lakhani
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Uzma Imam
- Pediatric Oncology Department, National Institute of Child Health, Karachi, Pakistan
| | - Junaid Zaheer
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan.,Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Asim Belgaumi
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan.,Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Zehra Fadoo
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan.,Department of Oncology, Aga Khan University, Karachi, Pakistan
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Hailu A, Mekasha A, Hailu D, Fentie AM, Korones DN, Gidey AM. Impact of Delay Prior to Treatment in Ethiopian Children with Acute Lymphoblastic Leukemia. Pediatric Health Med Ther 2023; 14:147-157. [PMID: 37197228 PMCID: PMC10184856 DOI: 10.2147/phmt.s406181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/01/2023] [Indexed: 05/19/2023] Open
Abstract
Introduction More than 85% of childhood malignancies occur in developing countries with less than a 30% cure rate as opposed to more than 80% cure rate in developed countries. This disproportionately significant difference might be due to delays in diagnosis, treatment initiation, lack of adequate supportive care, and treatment abandonment. We aimed to determine the impact of overall treatment delay on induction mortality of children with acute lymphoblastic leukemia treated at Tikur Anbessa specialized hospital (TASH). Methods A cross-sectional study was conducted among children who were treated from 2016 to 2019. Children with Down syndrome and relapsed leukemia were excluded from this study. Results A total of 166 children were included; most patients were males (71.7%). The mean age at diagnosis was 5.9 years. The median time interval from the onset of symptoms to the first TASH visit was 30 days and the median period from TASH's first clinic visit to diagnosis was 11 days. The median time to initiate chemotherapy after diagnosis was 8 days. The total median time from the first onset of symptoms to chemotherapy initiation was 53.5 days. Induction mortality was 31.3%. High-risk ALL and patients with an overall delay between 30 and 90 days were more likely to experience induction mortality. Discussion Patient and healthcare system delay is high compared to most studies done and a significant association has been noted with induction mortality. Efforts to expand the pediatric oncology service in the country and efficient diagnostic and treatment approach need to be established to reduce mortality associated with overall delay.
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Affiliation(s)
- Abel Hailu
- Department of Pediatrics and Child Health, Addis Ababa University Addis Ababa, Addis Ababa, Ethiopia
- Correspondence: Abel Hailu, Email
| | - Amha Mekasha
- Department of Pediatrics and Child Health, Addis Ababa University Addis Ababa, Addis Ababa, Ethiopia
| | - Daniel Hailu
- Department of Pediatrics and Child Health, Addis Ababa University Addis Ababa, Addis Ababa, Ethiopia
| | - Atalay Mulu Fentie
- Department of Pharmacology and Clinical Pharmacy, Addis Ababa University, Addis Ababa, Ethiopia
| | - David N Korones
- Department of Pediatrics, University of Rochester, New York, NY, USA
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Wang J, Bhakta N, Ayer Miller V, Revsine M, Litzow MR, Paietta E, Fedoriw Y, Roberts KG, Gu Z, Mullighan CG, Jones CD, Alexander TB. Acute Leukemia Classification Using Transcriptional Profiles From Low-Cost Nanopore mRNA Sequencing. JCO Precis Oncol 2022; 6:e2100326. [PMID: 35442720 PMCID: PMC9200386 DOI: 10.1200/po.21.00326] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 02/03/2022] [Accepted: 03/09/2022] [Indexed: 01/14/2023] Open
Abstract
PURPOSE Most cases of pediatric acute leukemia occur in low- and middle-income countries, where health centers lack the tools required for accurate diagnosis and disease classification. Recent research shows the robustness of using unbiased short-read RNA sequencing to classify genomic subtypes of acute leukemia. Compared with short-read sequencing, nanopore sequencing has low capital and consumable costs, making it suitable for use in locations with limited health infrastructure. MATERIALS AND METHODS We show the feasibility of nanopore mRNA sequencing on 134 cryopreserved acute leukemia specimens (26 acute myeloid leukemia [AML], 73 B-lineage acute lymphoblastic leukemia [B-ALL], 34 T-lineage acute lymphoblastic leukemia, and one acute undifferentiated leukemia). Using multiple library preparation approaches, we generated long-read transcripts for each sample. We developed a novel composite classification approach to predict acute leukemia lineage and major B-ALL and AML molecular subtypes directly from gene expression profiles. RESULTS We demonstrate accurate classification of acute leukemia samples into AML, B-ALL, or T-lineage acute lymphoblastic leukemia (96.2% of cases are classifiable with a probability of > 0.8, with 100% accuracy) and further classification into clinically actionable genomic subtypes using shallow RNA nanopore sequencing, with 96.2% accuracy for major AML subtypes and 94.1% accuracy for major B-lineage acute lymphoblastic leukemia subtypes. CONCLUSION Transcriptional profiling of acute leukemia samples using nanopore technology for diagnostic classification is feasible and accurate, which has the potential to improve the accuracy of cancer diagnosis in low-resource settings.
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Affiliation(s)
- Jeremy Wang
- Department of Genetics, University of North Carolina, Chapel Hill, NC
| | - Nickhill Bhakta
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Vanessa Ayer Miller
- Office of Clinical Translational Research, University of North Carolina, Chapel Hill, NC
| | - Mahler Revsine
- Department of Biology, University of North Carolina, Chapel Hill, NC
| | - Mark R. Litzow
- Division of Hematology and Transplant Center, Mayo Clinic Rochester, Rochester, MN
| | | | - Yuri Fedoriw
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC
| | - Kathryn G. Roberts
- Department of Pathology, St Jude Children's Research Hospital, Memphis, TN
| | - Zhaohui Gu
- Department of Computational and Quantitative Medicine & Systems Biology, Beckman Research Institute of City of Hope, Duarte, CA
| | | | - Corbin D. Jones
- Department of Biology, University of North Carolina, Chapel Hill, NC
| | - Thomas B. Alexander
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC
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Mills D, Abushanab S, Elhaloul A, El Nuweiry H, Shbair M, Qaddoumi I, Salman Z. Barriers to Care and Outcomes of Pediatric Acute Lymphoblastic Leukemia Treatment in the Gaza Strip. J Pediatr Hematol Oncol 2022; 44:e123-e126. [PMID: 34705357 DOI: 10.1097/mph.0000000000002338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 08/03/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Childhood acute lymphoblastic leukemia (ALL) is the most common pediatric cancer worldwide. Although children in high-income countries enjoy survival rates of ~90%, children in countries with limited resources suffer from survival rates of <35%. No published data on pediatric cancer incidence, management, or outcomes in the Gaza Strip are available. METHODS A retrospective cohort study was undertaken for pediatric (below 12 y of age) ALL diagnoses admitted to the only pediatric cancer ward in the Gaza Strip between 2010 and 2015. Outcomes included event-free survival (EFS) and overall survival (OS) calculated by Kaplan-Meier estimates. Events were defined as induction failure, relapse, and death. RESULTS The 3-year EFS estimate was 80% (95% confidence interval [CI], 66%-89%). The EFS at 1 and 3 years for high-risk ALL was 55% (95% CI, 27%-76%) and 23% (95% CI, 4%-51%), respectively. The 3-year OS was 93% (95% CI, 82%-97%). The 3-year OS for high-risk ALL was 69% (95% CI, 30%-90%). All 84 (100%) patients required referral to an outside hospital for definitive ALL diagnoses and induction therapy. Forty-four (52%) patients required at least one additional referral. CONCLUSIONS The overall outcomes demonstrated relatively high survival rates at 3 years which may be artificially elevated due to exclusion of adolescents, limited follow up, and deceased patient charts unavailable. Structural determinants of health in Gaza lead to limited diagnostic and treatment capabilities, limited access to advanced medical training, and reliance on out-of-territory transfers for care. These barriers impact the access to comprehensive pediatric care within the Gaza Strip.
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Affiliation(s)
- David Mills
- Boston Children's Hospital
- Harvard Medical School, Boston, MA
| | - Salah Abushanab
- Dr. Musa and Suhaila Nasir Pediatric Cancer Department, Pediatric Specialized Hospital, Gaza City
| | - Awad Elhaloul
- Dr. Musa and Suhaila Nasir Pediatric Cancer Department, Pediatric Specialized Hospital, Gaza City
| | - Heiam El Nuweiry
- Dr. Musa and Suhaila Nasir Pediatric Cancer Department, Pediatric Specialized Hospital, Gaza City
| | - Mahmoud Shbair
- Dr. Musa and Suhaila Nasir Pediatric Cancer Department, Pediatric Specialized Hospital, Gaza City
| | - Ibrahim Qaddoumi
- Global Pediatric Medicine Department, St. Jude Children's Research Hospital, Memphis, TN
| | - Zeena Salman
- Huda Al Masri Pediatric Cancer Department, Beit Jala Hospital, Beit Jala, Palestine
- Palestine Children's Relief Fund, Kent, OH
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10
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Jamal S, Meraj F, Mansoor N, Parveen S, Shaikh A, Jabbar N. Distribution of subtypes and immunophenotypic characterization of 1379 cases of paediatric acute leukaemia. Pak J Med Sci 2021; 37:805-811. [PMID: 34104169 PMCID: PMC8155440 DOI: 10.12669/pjms.37.3.3552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives: Acute leukaemia is the most common and highly curable childhood malignancy; subtyping and identification of antigens via immunophenotyping helps in treatment plan as well as minimal residual disease monitoring. Methods: This retrospective study was conducted at the Haematology section of the clinical laboratories of Ziauddin University Hospital and The Indus Hospital, Karachi conducted at January 1st, 2012 to December 31st, 2017. The study included 1379 cases of de novo acute leukemia from 2012 to 2017. Among these, 80% were diagnosed by using four color flowcytometry (FACS Calibur), 9% and 11% via immunohistochemistry on bone marrow trephine biopsy samples and morphological examination respectively. Results: The mean age of patients was 7.4 ± 4.3 years while male to female ratio was 1.75:1. Lymphoblastic leukaemia accounted for 77.2% and myeloid leukaemia 21.2%. Amongst lymphoblastic lineage, B-ALL was 80.4% while T-ALL was 19.6%. Among the phenotypic expression of B-ALL, CD79a (99.8%) had the highest positivity. In B-ALL, CD13 (29.8%) was the most common aberrant myeloid marker. Aberrant expression of CD79a observed in 11.1% of T-ALL cases. In non APL AML, aberrant expression of CD79a and CD19 was observed in 6.6% and 5.5% of cases respectively. Conclusion: Overall immunophenotypic profile, expression of aberrant phenotypes and subtype distribution in our patients was similar to international literature except for a relatively high frequency of T-ALL which was discordant from the western data.
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Affiliation(s)
- Saba Jamal
- Dr. Saba Jamal (MBBS) Diplomate American Board of Anatomic and Clinical Pathology, Diplomate American Board of Hematology), Haematology Clinical Laboratory, The Indus Hospital, Karachi, Pakistan
| | - Fatima Meraj
- Dr. Fatima Meraj (MBBS, MCPS, FCPS), Haematology Clinical Laboratory, The Indus Hospital, Karachi, Pakistan
| | - Neelum Mansoor
- Dr. Neelum Mansoor (MBBS, FCPS), Haematology Clinical Laboratory, The Indus Hospital, Karachi, Pakistan
| | - Sadia Parveen
- Ms. Sadia Parveen (M.Phil.), Indus Hospital Research Center, The Indus Hospital, Karachi, Pakistan
| | - Ameerah Shaikh
- Ameerah Shaikh, Medical Student, Ziauddin Medical College, Karachi, Pakistan
| | - Naeem Jabbar
- Dr. Naeem Jabbar (MBBS, FCPS). Paediatric Haematology Oncology, The Indus Hospital, Karachi, Pakistan
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11
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Wali R, Anjum S, Amjad A, Shaheen N, Khan SJ. Frequency of Infectious Mortality at the End of Induction Chemotherapy in Acute Lymphoblastic Leukemia and Lymphoma Patients: Findings From a Tertiary Care Cancer Center. Cureus 2021; 13:e13208. [PMID: 33717747 PMCID: PMC7943861 DOI: 10.7759/cureus.13208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background and objective In low- and low-to-middle-income countries (LMICs), the incidence of treatment-related mortality (TRM) in patients with acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL) is up to 52%. This study aimed to determine the mortality rate at the end of the induction phase of the treatment among patients with ALL and lymphoma at a tertiary care cancer center. Methods This retrospective study analyzed outcomes after induction chemotherapy in pediatric patients with acute leukemia and lymphoma at a tertiary care cancer center from January 2015 to December 2016. Information regarding demographics, clinical characteristics, and laboratory investigations were extracted and reviewed. Results Of the total 160 patients, 110 were males, and the mean age of the sample was 4.6 +2.8 years. B-cell leukemia (pre-B-ALL) was diagnosed in 84% (n=134), while 10% (n=6) had acute T-cell leukemia (pre-T-ALL) and 6% (n=10) had lymphoma. Sixteen patients (10%) died within the defined induction period, with 14 deaths occurring due to infections and two deaths resulting from chemotherapy-related toxicity. Conclusion Based on our findings, there is a significant prospect of mortality from infections during induction chemotherapy in patients with pediatric hematological malignancies.
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Affiliation(s)
- Rabia Wali
- Paediatric Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Sadia Anjum
- Paediatric Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | | | - Najma Shaheen
- Paediatric Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Saadiya Javed Khan
- Paediatrics and Child Health, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
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Alecsa MS, Moscalu M, Trandafir LM, Ivanov AV, Rusu C, Miron IC. Outcomes in Pediatric Acute Lymphoblastic Leukemia-A Single-Center Romanian Experience. J Clin Med 2020; 9:jcm9124052. [PMID: 33333966 PMCID: PMC7765371 DOI: 10.3390/jcm9124052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/09/2020] [Accepted: 12/11/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This study evaluates the main (para)clinical aspects and outcomes in a group of Romanian children diagnosed with acute lymphoblastic leukemia (ALL), under the conditions of antileukemic treatment according to an adapted ALL IC Berlin-Frankfurt-Munster (BFM) 2002 protocol. METHODS We performed a retrospective single-center study of 125 children diagnosed with ALL between 2010 and 2016. Standard forms were used for data collection of variate clinical and paraclinical parameters. RESULTS The children were predominantly male (64.8%) and their median age at diagnosis was 5 years. A total of 107 patients were diagnosed with precursor B-cell acute lymphoblastic leukemia (BCP)-ALL and 18 with T-cell acute lymphoblastic leukemia T-ALL. Multiplex reverse transcription polymerase chain reaction RT-PCR assay for ETV6-RUNX1, BCR-ABL, E2A-PBX1, KMT2A-AFF1, and STIL-TAL1 fusion genes was performed in 111 patients. ETV6-RUNX1 translocation was detected in 18.9% of patients, while BCR-ABL1 and E2A-PBX1 rearrangements were seen in 2.7% and 3.6%, respectively. Complete remission at the end of induction phase was obtained in 89.6% of patients. The overall relapse rate was 11.2%, with 11 early and 3 late relapses. The 5-year overall survival rate in BCP-ALL was 81.6% and in T-ALL 71.4%. CONCLUSIONS The 5-year overall and event-free survival rates in our study were slightly lower than those reported in developed countries, so the patients' outcomes are encouraging.
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Affiliation(s)
- Mirabela-Smaranda Alecsa
- Department Mother and Child Care, Division of Neonatology, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.-S.A.); (A.-V.I.); (C.R.); (I.-C.M.)
- Department of Pediatric Hematology and Oncology, Sf. Maria Children’s Emergency Hospital, 700309 Iasi, Romania
| | - Mihaela Moscalu
- Department of Preventive Medicine and Interdisciplinarity, Division of Informatics and Medical Statistics, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
- Correspondence: (M.M.); (L.-M.T.)
| | - Laura-Mihaela Trandafir
- Department Mother and Child Care, Division of Neonatology, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.-S.A.); (A.-V.I.); (C.R.); (I.-C.M.)
- Department of Pediatrics, Sf. Maria Children’s Emergency Hospital, 700309 Iasi, Romania
- Correspondence: (M.M.); (L.-M.T.)
| | - Anca-Viorica Ivanov
- Department Mother and Child Care, Division of Neonatology, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.-S.A.); (A.-V.I.); (C.R.); (I.-C.M.)
- Department of Pediatrics, Sf. Maria Children’s Emergency Hospital, 700309 Iasi, Romania
| | - Cristina Rusu
- Department Mother and Child Care, Division of Neonatology, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.-S.A.); (A.-V.I.); (C.R.); (I.-C.M.)
- Department of Medical Genetics, Sf. Maria Children’s Emergency Hospital, 700309 Iasi, Romania
| | - Ingrith-Crenguta Miron
- Department Mother and Child Care, Division of Neonatology, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.-S.A.); (A.-V.I.); (C.R.); (I.-C.M.)
- Department of Pediatric Hematology and Oncology, Sf. Maria Children’s Emergency Hospital, 700309 Iasi, Romania
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13
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Improving outcome of childhood acute lymphoblastic leukemia in Indian Subcontinent by focussing on treatment and prevention of infections. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2020. [DOI: 10.1016/j.phoj.2020.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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14
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Mahmood N, Shahid S, Bakhshi T, Riaz S, Ghufran H, Yaqoob M. Identification of significant risks in pediatric acute lymphoblastic leukemia (ALL) through machine learning (ML) approach. Med Biol Eng Comput 2020; 58:2631-2640. [PMID: 32840766 DOI: 10.1007/s11517-020-02245-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 08/02/2020] [Indexed: 11/25/2022]
Abstract
Pediatric acute lymphoblastic leukemia (ALL) through machine learning (ML) technique was analyzed to determine the significance of clinical and phenotypic variables as well as environmental conditions that can identify the underlying causes of child ALL. Fifty pediatric patients (n = 50) included who were diagnosed with acute lymphoblastic leukemia (ALL) according to the inclusion and exclusion criteria. Clinical variables comprised of the blood biochemistry (CBC, LFTs, RFTs) results, and distribution of type of ALL, i.e., T ALL or B ALL. Phenotypic data included the age, sex of the child, and consanguinity, while environmental factors included the habitat, socioeconomic status, and access to filtered drinking water. Fifteen different features/attributes were collected for each case individually. To retrieve most useful discriminating attributes, four different supervised ML algorithms were used including classification and regression trees (CART), random forest (RM), gradient boosted machine (GM), and C5.0 decision tree algorithm. To determine the accuracy of the derived CART algorithm on future data, a ten-fold cross validation was performed on the present data set. The ALL was common in children of age below 5 years in male patients whole belonged to middle class family of rural areas. (B-ALL) was most frequent as compared with T-ALL. The consanguinity was present in 54% of cases. Low levels of platelets and hemoglobin and high levels of white blood cells were reported in child ALL patients. CART provided the best and complete fit for the entire data set yielding a 99.83% model fit accuracy, and a misclassification of 0.17% on the entire sample space, while C5.0 reported 98.6%, random forest 94.44%, and gradient boosted machine resulted in 95.61% fitting. The variable importance of each primary discriminating attribute is platelet 43%, hemoglobin 24%, white blood cells 4%, and sex of the child 4%. An overall accuracy of 87.4% was recorded for the classifier. Platelet count abnormality can be considered as a major factor in predicting pediatric ALL. The machine learning algorithms can be applied efficiently to provide details for the prognosis for better treatment outcome. Graphical Abstract Identification of significant risks in pediatric acute lymphoblastic leukemia (ALL) through machine learning (ML) approach.
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Affiliation(s)
- Nasir Mahmood
- Department of Biochemistry, Human Genetics and Molecular Biology, University of Health Sciences (UHS), Lahore, Pakistan. .,Department of Cell and System Biology, University of Toronto, Toronto, Canada.
| | - Saman Shahid
- Department of Sciences & Humanities, Foundation for Advancement of Science and Technology (FAST), National University of Computer and Emerging Sciences (NUCES), Lahore, Pakistan
| | - Taimur Bakhshi
- Department of Sciences & Humanities, Foundation for Advancement of Science and Technology (FAST), National University of Computer and Emerging Sciences (NUCES), Lahore, Pakistan
| | - Sehar Riaz
- The School of Allied Health Sciences, Children's Hospital and Institute of Child Health, Lahore, Pakistan
| | - Hafiz Ghufran
- The School of Allied Health Sciences, Children's Hospital and Institute of Child Health, Lahore, Pakistan
| | - Muhammad Yaqoob
- Department of Medical Genetics, Children's Hospital and Institute of Child Health, Lahore, Pakistan
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Prednisolone Prophase for a Week Versus Upfront Multiagent Chemotherapy in Childhood Acute Lymphoblastic Leukemia: An Analysis With Reference to Induction Mortality in a Developing Country. J Pediatr Hematol Oncol 2020; 42:181-184. [PMID: 31688627 DOI: 10.1097/mph.0000000000001636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In childhood acute lymphoblastic leukemia, high treatment-related mortality, especially in the induction phase of treatment, is a major challenge for developing countries. The reasons are multifactorial, including a late presentation with higher disease burden, malnourishment, and limited support services. These factors may aggravate the toxic effects of upfront multiagent chemotherapy in terms of severe neutropenic sepsis and tumor lysis. Therefore, instead of upfront chemotherapy, we offered prednisolone prophase for 1 week with the objective of balancing the antileukemic versus the toxic effect of treatment. The data of 538 patients who received induction with this approach (cohort B) are compared for induction mortality with previous records of 438 patients (cohort A) treated with upfront chemotherapy. In the presence of similar clinical characteristics including age, sex, risk group, and phenotype in both cohorts, a significant difference was found in overall induction mortality of 9% in cohort B versus 14% in cohort A (P<0.05). This difference was also significant in the high-risk and T-cell phenotype, which strengthens our hypothesis that patients with higher burden of disease may experience more fatal toxic effects with upfront intensive chemotherapy. Therefore, we suggest that the prednisolone prophase approach is beneficial to control the disease with less severe toxic effects in our settings.
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16
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Naeem B, Moorani KN, Anjum M, Imam U. Tumor lysis syndrome in pediatric acute lymphoblastic leukemia at tertiary care center. Pak J Med Sci 2019; 35:899-904. [PMID: 31372114 PMCID: PMC6659073 DOI: 10.12669/pjms.35.4.715] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives: Tumor lysis syndrome (TLS) is common complication of acute lymphoblastic leukemia (ALL). It is characterized by presence of two or more of hyperkalemia, hyperuricemia, hyperphosphatemia and hypocalcemia. TLS may cause acute kidney injury (AKI), arrhythmias and seizures. Our objective was to determine the frequency of TLS and its biochemical abnormalities in children with ALL. Methods: A retrospective study on 91 children, aged 2-13 years with ALL was carried out in Nephrology and Oncology departments of National Institute of Child Health, Karachi from January 2016 to December 2017. Patients already received chemotherapy were excluded. Data including risk categories, immunophenotyping, laboratory parameters like complete blood picture, serum creatinine (SCr), potassium(K), calcium (Ca), phosphorus(P) and uric acid (UA) on day 0,3 and 7 after chemotherapy were collected. Data analyzed on SPSS using descriptive statistics. Independent t- test was applied to compare means and P- value<0.05 was taken as significant. Results: Ninety-one children with mean age of 6.39±3.08 years were studied. Male were 57% and 43% female. High risk ALL were 61.5%. Pre –BALL were 82.4% and 17.5% had T-cell ALL. All patients had anemia (hemoglobin7.69±2.66 g/dl) and thrombocytopenia (43.61± 18.6 x109) where as hyperleukocytosis and blast cells were observed in 20.87% and 73.6% respectively. Comparing the biochemical parameters of ALL, the difference in SCr from D0 vs D3 (0.46±0.16 vs0.54± 0.35 and D7, 0.44±0.22) was significant (p=0.001). Similarly, difference in UA (D0, 4.12±2.40 vs D3, 3.82±1.73 and D7, 3.56±1.42), SP (D0, 4.24±1.34 vs D3, 4.61±1.76 and D7,4.13±1.07mg/dl)and for K (p=0.038) was significant. There was no difference in Ca from D0 vs D3 (0.092) and D7 (0.277). TLS was found in 62.6% children, it was chemotherapy induced in 72% and spontaneous in 28%. Clinical-TLS was observed in 14% and all CTLS had AKI. Hyperuricemia and hyperphosphatemia were the most common biochemical abnormalities in laboratory-TLS and CTLS. Conclusion: TLS was found in 62.6% despite preventive measures. Early recognition and treatment is essential to avoid morbidity and mortality.
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Affiliation(s)
- Bilqis Naeem
- Bilquis Naeem, MBBS, FCPS, FCPS, Assistant Professor, Pediatric Medicine, Departments of Pediatric Nephrology, National Institute of Child Health (NICH), Jinnah Sindh Medical University (JSMU) Karachi, Pakistan
| | - Khemchand N Moorani
- Prof. Khemchand N Moorani, FCPS, MCPS, MBBS, Departments of Pediatric Nephrology, National Institute of Child Health (NICH), Jinnah Sindh Medical University (JSMU) Karachi, Pakistan
| | - Misbah Anjum
- Misbah Anjum, MBBS, FCPS, Assistant Professor, Pediatric Medicine Pediatric Medical Unit III, National Institute of Child Health (NICH), Jinnah Sindh Medical University (JSMU) Karachi, Pakistan
| | - Uzma Imam
- Uzma Imam MBBS, Senior Medical officer, Pediatric Oncology, National Institute of Child Health (NICH), Jinnah Sindh Medical University (JSMU) Karachi, Pakistan
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17
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Revisiting the complete blood count and clinical findings at diagnosis of childhood acute lymphoblastic leukemia: 10-year experience at a single center. Hematol Transfus Cell Ther 2018; 41:57-61. [PMID: 30793106 PMCID: PMC6371227 DOI: 10.1016/j.htct.2018.05.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 05/21/2018] [Indexed: 12/21/2022] Open
Abstract
Background Heterogeneity regarding clinical and laboratory findings at diagnosis of acute lymphoblastic leukemia exists. The frequency of complete blood count abnormalities and its combinations, symptoms and physical findings were investigated in Hispanic children from an open population at the diagnosis of acute lymphoblastic leukemia. Methods The patient charts and electronic records of under 16-year-old children diagnosed with acute lymphoblastic leukemia over 10 years at a regional hematology center of a university hospital were analyzed to retrieve data concerning the complete blood count at first evaluation. Type and distribution of abnormal data, frequency of symptoms and physical findings at presentation were documented. Results The records of 203 children aged 0–15 years diagnosed with acute lymphoblastic leukemia from 2006 to 2016 were revisited. The results of the blood workup showed a median white blood cell count of 7120 × 109/L (range: 450–600,000 × 109/L), and a median hemoglobin concentration of 7.5 g/dL (range: 2.4–15.3 g/dL), whereas the median platelet count was 47,400 × 109/L (range: 4000–544,000 × 109/L). Leukocytosis and leukopenia were present in 36.6% and 36.1% of cases, respectively; anemia was diagnosed in 82.9% children. The order of frequency for major clinical symptoms was fatigue 62%, fever 60%, bone and joint pain 39%, hyporexia 33% and weight loss 21%, while main physical findings were hepatomegaly 78%, splenomegaly 63%, lymphadenopathy 57%, pallor 48%, and purpura 30%. Conclusion Data differing from those classically expected at diagnosis of acute lymphoblastic leukemia in children were documented in a cohort of Hispanic children over one decade with a wide spectrum of complete blood count abnormalities, forms of presentation and frequency of physical findings.
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18
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Pettit T, Cole N, Leung W, Ballantine K, Macfarlane S. Analysis of common cytogenetic abnormalities in New Zealand pediatric ALL shows ethnically diverse carriage of ETV6-RUNX1, without a corresponding difference in survival. Pediatr Blood Cancer 2017; 64. [PMID: 28598545 DOI: 10.1002/pbc.26676] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 05/15/2017] [Accepted: 05/16/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND The frequency of common cytogenetic abnormalities in pediatric acute lymphoblastic leukemia (ALL) is known to vary by geographic location and ethnic origin. This study aimed to determine the frequency of hypodiploidy, ETV6-RUNX1, BCR-ABL1, and MLL rearrangement within New Zealand's pediatric ALL population and to assess whether the frequency of these ALL prognostic markers varies according to ethnicity. PROCEDURE The New Zealand Children's Cancer Registry provided information for all registered pediatric ALL patients that were diagnosed between 2000 and 2009, with medical records available for 246 patients. Each patient's medical record was reviewed to determine the frequency of hypodiploidy, ETV6-RUNX1, BCR-ABL1, MLL rearrangement, and cell lineage. Chi-square tests for independence were undertaken to compare the frequencies of cytogenetic abnormalities according to prioritized ethnicity. RESULTS The frequency of cytogenetic ALL abnormalities in the New Zealand pediatric population were consistent with international reference values. A low frequency of ETV6-RUNX1 was evident for Maori pediatric ALL patients (5.4%, P = 0.018), when compared to Pacific peoples (21.1%) and non-Maori/non-Pacific peoples (27.4%). This has not impacted on outcome, however, with equivalent 5-year overall survival being observed in Maori (89.4%) compared to Pacific peoples (92.0%) and non-Maori/non-Pacific peoples (90.2%). CONCLUSIONS A lower frequency of the favorable prognostic marker ETV6-RUNX1 was observed in Maori pediatric ALL patients. This did not translate into poorer survival. Future research into biological and nonbiological prognostic factors in this patient population may assist in explaining this finding.
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Affiliation(s)
- Tristan Pettit
- Children's Haematology Oncology Centre, Christchurch Hospital, Christchurch, New Zealand
| | - Nyree Cole
- Starship Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand
| | - Wingchi Leung
- Starship Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand
| | - Kirsten Ballantine
- Children's Haematology Oncology Centre, Christchurch Hospital, Christchurch, New Zealand.,National Child Cancer Network NZ, Auckland, New Zealand
| | - Scott Macfarlane
- Starship Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand.,National Child Cancer Network NZ, Auckland, New Zealand
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Alvarez E, Seppa M, Rivas S, Fuentes L, Valverde P, Antillón-Klussmann F, Castellanos M, Sweet-Cordero EA, Messacar K, Kurap J, Bustamante M, Howard SC, Efron B, Luna-Fineman S. Improvement in treatment abandonment in pediatric patients with cancer in Guatemala. Pediatr Blood Cancer 2017; 64. [PMID: 28423236 DOI: 10.1002/pbc.26560] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 02/12/2017] [Accepted: 02/19/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Treatment refusal and abandonment are major causes of treatment failure for children with cancer in low- and middle-income countries (LMICs), like Guatemala. This study identified risk factors for and described the intervention that decreased abandonment. METHODS This was a retrospective study of Guatemalan children (0-18 years) with cancer treated at the Unidad Nacional de Oncología Pediátrica (UNOP), 2001-2008, using the Pediatric Oncology Network Database. Treatment refusal was a failure to begin treatment and treatment abandonment was a lapse of 4 weeks or longer in treatment. The impact of medicina integral, a multidisciplinary psychosocial intervention team at UNOP was evaluated. Cox proportional hazards analysis identified the effect of demographic and clinical factors on abandonment. Kaplan-Meier analysis estimated the survival. RESULTS Of 1,789 patients, 21% refused or abandoned treatment. Abandonment decreased from 27% in 2001 to 7% in 2008 following the implementation of medicina integral. Factors associated with increased risk of refusal and abandonment: greater distance to the centre (P < 0.001), younger age (P = 0.017) and earlier year of diagnosis (P < 0.001). Indigenous race/ethnicity (P = 0.002) was associated with increased risk of abandonment alone. Abandonment correlated with decreased overall survival: 0.57 ± 0.02 (survival ± standard error) for those who completed therapy versus 0.06 ± 0.02 for those who abandoned treatment (P < 0.001) at 8.3 years. CONCLUSION This study identified distance, age, year of diagnosis and indigenous race/ethnicity as risk factors for abandonment. A multidisciplinary intervention reduced abandonment and can be replicated in other LMICs.
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Affiliation(s)
- Elysia Alvarez
- Division of Hematology/Oncology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Midori Seppa
- Stanford University School of Medicine, Palo Alto, California
| | - Silvia Rivas
- Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | - Lucia Fuentes
- Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | | | | | | | - E Alejandro Sweet-Cordero
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, UCSF Benioff Children's Hospital, San Francisco, California
| | - Kevin Messacar
- Section of Hospital Medicine and Infectious Diseases, Department of Pediatrics, University of Colorado/Children's Hospital Colorado, Aurora, Colorado
| | - John Kurap
- Hilo Bay Clinic, Community Health Center, Hilo, Hawaii
| | | | - Scott C Howard
- School of Health Studies, University of Memphis, Tennessee
| | - Bradley Efron
- Department of Statistics and Biostatistics, Stanford University, Palo Alto, California
| | - Sandra Luna-Fineman
- Division of Hematology/Oncology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California.,Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
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Jawaid A, Arif K, Brown N, Fadoo Z. Clinical characteristics of childhood cancer in emergency room in a tertiary hospital in Pakistan. World J Emerg Med 2016; 7:300-302. [PMID: 27965725 DOI: 10.5847/wjem.j.1920-8642.2016.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Amna Jawaid
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi 74800, Pakistan
| | - Khubaib Arif
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi 74800, Pakistan
| | - Nick Brown
- Visiting faculty, Salisbury District Hospital, Salisbury, United Kingdom
| | - Zehra Fadoo
- Department of Oncology and Pediatrics, Aga Khan University Hospital, Karachi 74800, Pakistan
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The Impact of Socioeconomic Factors on the Outcome of Childhood Acute Lymphoblastic Leukemia (ALL) Treatment in a Low/Middle Income Country (LMIC). J Pediatr Hematol Oncol 2016; 38:587-596. [PMID: 27467375 DOI: 10.1097/mph.0000000000000653] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Survival for childhood acute lymphoblastic leukemia (ALL) has improved significantly, but these benefits may not be available to many children from low and middle income countries, where reasons for treatment failure may be unique to their environment. We retrospectively reviewed data on pediatric (1 to 18 y or younger) patients with newly diagnosed ALL treated over 5 years at a children's cancer hospital in Pakistan. Patients were treated with modified Berlin-Frankfurt-Muenster -based therapy without risk stratification. There were 255 children with a median age of 7 years (mean, 7.65 y) and a male preponderance (M:F=1.6:1). 20% had T-ALL, one-third had white blood cells >50×10/L and 13.7% central nervous system disease. A majority (56.5%) was malnourished. In total, 49 (19.2%) died before the end of induction and 21 died in complete remission. Most deaths were infection-related. A total of 50 patients relapsed and 19 abandoned therapy after complete remission. Five-year overall survival is 52.9% with abandonment censored and 45.8% with abandonment as an event. Overall survival was related to socioeconomic status but not to known risk factors. The outcome of ALL at our center is suboptimal and associated with factors not commonly seen in developed countries. Special attention to early diagnosis, infection control, and parental educational are needed to improve the survival.
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Hossain MS, Begum M, Mian MM, Ferdous S, Kabir S, Sarker HK, Karim S, Choudhury S, Khan A, Khan ZJ, Karim-Kos HE. Epidemiology of childhood and adolescent cancer in Bangladesh, 2001-2014. BMC Cancer 2016; 16:104. [PMID: 26879701 PMCID: PMC4754803 DOI: 10.1186/s12885-016-2161-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 02/10/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Cancer burden among children and adolescents is largely unknown in Bangladesh. This study aims to provide a comprehensive overview on childhood and adolescent cancers and to contribute to the future strategies to deal with these diseases in Bangladesh. METHODS Data on malignant neoplasms in patients aged less than 20 years diagnosed between 2001 and 2014 (N = 3143) in Bangladesh was collected by the National Institute of Cancer Research and Hospital and ASHIC Foundation. The age pattern and distribution of cancer types were analysed and the incidence rates were calculated. RESULTS The age-standardised incidence rate was 7.8 per million person-years for children (0-14 years) in the last time period (2011-2014). Retinoblastoma (25%) and leukaemia (18%) were the most common childhood cancers. For adolescents (15-19 years), the age-specific incidence rate was 2.1 per million person-years in the same time period. Most common adolescent cancers were malignant bone tumours (38%), germ cell and gonadal tumours (17%), and epithelial tumours (16%). There were more boys affected (M: F ratio 2.0 in children and 1.4 in adolescents) than girls. CONCLUSION Cancer incidences were lower than expected most likely due to a low level of awareness about cancer among clinicians and the population, inadequate access to health care, lack of diagnostic equipment and incomplete recording of cases. Improvements on different levels should be made to get a better epidemiologic insight and to detect cancer earlier resulting in a better outcome for affected children and adolescents.
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Affiliation(s)
- Mohammad Sorowar Hossain
- Faculty of Basic Sciences, Bangladesh University of Health Sciences, Darus Salam, Mirpur-1, Dhaka, 1216, Bangladesh.
| | - Mamtaz Begum
- National Institute of Cancer Research and Hospital, Dhaka, Bangladesh.
| | | | | | | | | | - Sabina Karim
- National Institute of Cancer Research and Hospital, Dhaka, Bangladesh.
| | | | - Asaduzzaman Khan
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia.
| | - Zohora Jameela Khan
- ASHIC Foundation, Dhaka, Bangladesh. .,Dhaka Medical College and Hospital, Dhaka, Bangladesh.
| | - Henrike E Karim-Kos
- Department of Public Health, Erasmus MC University Medical Centre, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
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