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Bansal D, Davidson A, Supriyadi E, Njuguna F, Ribeiro RC, Kaspers GJL. SIOP PODC adapted risk stratification and treatment guidelines: Recommendations for acute myeloid leukemia in resource-limited settings. Pediatr Blood Cancer 2023; 70:e28087. [PMID: 31774234 DOI: 10.1002/pbc.28087] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 10/21/2019] [Accepted: 10/30/2019] [Indexed: 01/09/2023]
Abstract
In low- and middle-income countries (LMICs), limited resources, suboptimal risk stratification, and disproportionate patient-to-infrastructure ratio result in low survival of patients with acute myeloid leukemia (AML). A high incidence of relapse, inherent to the biology, renders management arduous. The challenge of treating AML in LMICs is of balancing the intensity of myelosuppressive chemotherapy, which appears necessary for cure, with available supportive care, which influences treatment-related mortality. The recommendations outlined in this paper are based on published evidence and expert opinion. The principle of this adapted protocol is to tailor treatment to available resources, reduce preventable toxic death, and direct limited resources toward those children who are most likely to be cured.
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Affiliation(s)
- Deepak Bansal
- Department of Pediatrics, Hematology-Oncology Unit, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Alan Davidson
- Haematology-Oncology Service, Red Cross Children's Hospital, Cape Town, South Africa
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Eddy Supriyadi
- Pediatric Hematology-Oncology Division, Department of Pediatrics, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Festus Njuguna
- Department of Child Health and Paediatrics, Moi University, Eldoret, Kenya
| | - Raul C Ribeiro
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Gertjan J L Kaspers
- Department of Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Totadri S, Srinivasan HN, Joseph LL, Boddu D, Mathew LG, John R. A single assessment of methotrexate levels at 42 hours permits safe administration and early discharge in children with lymphoblastic lymphoma and leukemia receiving high-dose methotrexate. Pediatr Hematol Oncol 2021; 38:434-443. [PMID: 33764242 DOI: 10.1080/08880018.2020.1863535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
High-dose methotrexate (HDMTX) is an important component of treatment in pediatric acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LL). Optimal rescue therapy is essential for the safe administration of HDMTX. A cost-effective strategy that does not compromise safety is necessary for low- and middle-income countries. Consecutive admissions for HDMTX in children with ALL and LL over 12 months were analyzed. The dose of HDMTX was 3 g/m2 in B-ALL and B-LL and 5 g/m2 in T-ALL and T-LL. A methotrexate level was measured at 42 hours of starting HDMTX infusion (T42-MTX). Three doses of folinic acid at T42, T48, and T54 and alkalinized hydration till T54 were administered if T42-MTX <1 µM. A total of 282 cycles of HDMTX that were administered in 71 patients were analyzed. T42-MTX was <1 µM in 266 (94.3%) cycles. T42-MTX was ≥1 µM in 12% and 3% of cycles of HDMTX administered at a dose of 5 g/m2 and 3 g/m2, respectively (p = .074). The median duration of hospitalization for HDM was three days and did not differ with the dose of HDMTX administered (p = .427). Mucositis, delayed recovery of blood counts, and hospitalization for reversible toxicity occurred after 21 (7.4%), 28 (9.9%), and 19 (6.7%) cycles of HDMTX, respectively. Mucositis was greater following the administration of 5 g/m2 of HDMTX. A single T42-MTX measurement permits the safe administration of HDMTX and an expedited discharge from the hospital within three days in more than 90% of children with ALL/LL.
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Affiliation(s)
- Sidharth Totadri
- Paediatric Haematology/Oncology Unit, Department of Paediatrics, Christian Medical College and Hospital, Vellore, India
| | - Hema Nalapullu Srinivasan
- Paediatric Haematology/Oncology Unit, Department of Paediatrics, Christian Medical College and Hospital, Vellore, India
| | - Leenu Lizbeth Joseph
- Paediatric Haematology/Oncology Unit, Department of Paediatrics, Christian Medical College and Hospital, Vellore, India
| | - Deepthi Boddu
- Paediatric Haematology/Oncology Unit, Department of Paediatrics, Christian Medical College and Hospital, Vellore, India
| | - Leni Grace Mathew
- Paediatric Haematology/Oncology Unit, Department of Paediatrics, Christian Medical College and Hospital, Vellore, India
| | - Rikki John
- Paediatric Haematology/Oncology Unit, Department of Paediatrics, Christian Medical College and Hospital, Vellore, India
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Khalek ER, Afungchwi GM, Beltagy ME, Mariam N, Zaki H, Israels T, Molyneux E, Howard SC, Patte C, Schoeman J, Ladas E, Zaghloul MS, ElDeen YS, Ahmed S, Kamal S, Bouffet E, Pritchard-Jones K, Hessissen L. Highlights from the 13th African Continental Meeting of the International Society of Paediatric Oncology (SIOP), 6-9 March 2019, Cairo, Egypt. Ecancermedicalscience 2019; 13:932. [PMID: 31281429 PMCID: PMC6592710 DOI: 10.3332/ecancer.2019.932] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Indexed: 01/17/2023] Open
Abstract
The 13th African continental meeting of the international society of paediatric oncology, held on 6-9 March 2019 in Cairo, was organised in collaboration with the Children Cancer Hospital (57357) in Egypt and the global parents' organisation (Childhood Cancer International) and supported by a large international faculty. With 629 delegates from 37 countries (24 African), this was the largest forum of healthcare professionals focused on children and young people with cancer in Africa to showcase advances and discuss further improvements. Three targeted workshops, on nursing care, pharmacy and nutrition, attracted large numbers and catalysed new collaborative initiatives in supportive care studies, extended roles for pharmacists in quality control and care delivery and addressed malnutrition concurrently with cancer treatment. The Collaborative Wilms Tumour Africa Project, open in seven sub-Saharan countries, and the trials in Burkitt's lymphoma reported encouraging outcomes with further initiatives in supportive care (the supportive care for children with cancer in Africa project). While acknowledging deficits in radiotherapy provision, available in only 23 of 52 African countries, centres with facilities reported their technical advances that benefit patients. Of great importance for children with brain tumours, who are underdiagnosed in Africa, was the first announcement of African paediatric neuro-oncology society, whose 63 current members aim to tackle the shortage of neurosurgeons through training fellowships, workshops and a dedicated conference. The congress provided the opportunity to discuss how African countries will work with the WHO global initiative aiming to improve childhood cancer survival to 60% in all countries by 2030. This conference report is dedicated to the three Kenyan delegates who died tragically on the Ethiopian Airlines flight ET302 on their way home, full of new ideas and pride in what they had achieved so far. All those who heard their presentations are determined to continue their excellent work to improve cancer care for children in Africa.
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Affiliation(s)
- Elhamy Rifky Khalek
- Professor of Paediatric Oncology, Faculty of Medicine, Zagazig University, Children's Cancer Hospital Egypt 57357, Cairo 11617, Egypt
| | - Glenn M Afungchwi
- Manager, Cameroon Baptist Convention Health Services Childhood Cancer Programme, Cameroon University of Stellenbosch, Stellenbosch 7602, South Africa
| | - Mohamed El Beltagy
- Professor of neurosurgery, Faculty of Medicine, Cairo University, Kasr El Aini, Cairo, and Head of Neurosurgery, Children's Cancer Hospital Egypt 57357, Cairo 11617, Egypt
| | - Ndagire Mariam
- Nursing officer, Uganda Cancer Institute, Kampala, PO Box 3935 Uganda
| | - Hoda Zaki
- Dean, Faculty of Nursing, Helwan University, Modern University for Technology and Information (MTI), Cairo, Egypt
| | - Trijn Israels
- Princess Màxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
| | - Elizabeth Molyneux
- Paediatric Department, College of Medicine/Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Scott C Howard
- The University of Tennessee Health Science Center, Memphis, TN 38163 USA
| | - Catherine Patte
- CLCC G Groupe Franco-Africain d'Oncologie Pédiatrique (GFAOP), Institut Gustave Roussy, France and GFAOP, 94800 Villejuif, France
| | - Judy Schoeman
- Chief dietician, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town 7530, South Africa
| | - Elena Ladas
- Associate Professor for Global Integrative Medicine, Director, Integrative Therapies Program, Columbia University Medical Center, USA
| | - Mohamed S Zaghloul
- Professor of Radiation Oncology, National Cancer Institute; Chair, Radiation Oncology Department, Children's Cancer Hospital Egypt 57357, Cairo, Egypt
| | - Yasser S ElDeen
- Professor of Pediatric Surgery, Alexandria University, Alexandria 21568, Egypt
| | - Soha Ahmed
- Chairman, Clinical Oncology Department, Aswan University and Consultant, Children's Cancer Hospital Egypt 57357, Cairo, Egypt
| | - Sherif Kamal
- Director, Department of Pharmaceutical Services, Children's Cancer Hospital Egypt 57357, Cairo, Egypt
| | - Eric Bouffet
- President, International Society of Paediatric Oncology (SIOP), Professor of Neuro-oncology, Sick Children's Hospital, Toronto ON M5G 1X8, Canada
| | - Kathy Pritchard-Jones
- SIOP President-elect, Professor of Paediatric Oncology, UCL Great Ormond Street Institute of Child Health, University College London, London WC1E 6BT, UK
| | - Laila Hessissen
- SIOP Africa Continental President, Professor of Paediatrics, Pediatric Haematology and Oncology Center, University Mohamed V Rabat, Rabat BP.8007.UN, Morocco
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Lam CG, Howard SC, Bouffet E, Pritchard-Jones K. Science and health for all children with cancer. Science 2019; 363:1182-1186. [DOI: 10.1126/science.aaw4892] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Each year ~429,000 children and adolescents aged 0 to 19 years are expected to develop cancer. Five-year survival rates exceed 80% for the 45,000 children with cancer in high-income countries (HICs) but are less than 30% for the 384,000 children in lower-middle-income countries (LMICs). Improved survival rates in HICs have been achieved through multidisciplinary care and research, with treatment regimens using mostly generic medicines and optimized risk stratification. Children’s outcomes in LMICs can be improved through global collaborative partnerships that help local leaders adapt effective treatments to local resources and clinical needs, as well as address common problems such as delayed diagnosis and treatment abandonment. Together, these approaches may bring within reach the global survival target recently set by the World Health Organization: 60% survival for all children with cancer by 2030.
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