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Sripornsawan P, Chavananon S, Kittivisuit S, Songthawee N, McNeil EB, Chotsampancharoen T. Long-term survival outcome of childhood acute myeloid leukemia: a 43-year experience in Thailand, a resource-limited country. Leuk Lymphoma 2024:1-10. [PMID: 39058288 DOI: 10.1080/10428194.2024.2382916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/12/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024]
Abstract
Although there have been advances in treating pediatric patients with acute myeloid leukemia (AML) in developed countries, outcomes in low- to middle-income countries remain poor. The goal of this study was to investigate the outcomes in children with AML who were treated at a tertiary care center in Thailand. We divided the study into 4 research periods based on the chemotherapy protocols employed. The 5-year probabilities of event-free survival (pEFS) rates for periods 1-4 were 19.0%, 20.6%, 17.4%, and 37.3% (p value = 0.32), while the 5-year probabilities of overall survival (pOS) rates were 19.0%, 24.7%, 18.7%, and 42.5% (p value = 0.18), respectively. The multivariable model indicated an improvement in 5-year pOS between periods 1 and 4 (p value = 0.04). Age, white blood cell count, and study period were significant predictors of survival outcomes. The pOS of AML patients improved over time, increasing from 19.0% to 42.5%.
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Affiliation(s)
- Pornpun Sripornsawan
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Shevachut Chavananon
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Sirinthip Kittivisuit
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Natsaruth Songthawee
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Edward B McNeil
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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2
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Mamo W, Moges A, Yesuf SA, Mohamedsaid A, Arega G. Treatment outcomes of pediatrics acute myeloid leukemia (AML) and associated factors in the country's tertiary referral hospital, Ethiopia. BMC Cancer 2024; 24:640. [PMID: 38789952 PMCID: PMC11127368 DOI: 10.1186/s12885-024-12404-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 05/20/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Pediatric Acute Myeloid Leukemia (AML) is a major cause of morbidity and mortality in children with cancer in Africa and other developing continents. Systemic chemotherapy and effective supportive care have significantly contributed to increased survival rates of pediatric AML in developed countries reaching approximately 70%. There is a paucity of contextual data regarding overall and event-free survival outcomes in children with acute myeloid leukemia in developing countries and most centers in Africa provide palliative care. The objective of this study was to assess the overall survival, event-free survival, and associated factors in pediatric AML patients treated in Ethiopia. METHODS This retrospective study was conducted on Pediatric AML patients treated at Tikur Anbessa Hospital between January 1, 2015, and May 30, 2022. The socio-demographic profile of patients, the clinical characteristics, the biochemical and morphological subtypes of AML were analyzed using SPSS version 25. The Kaplan-Meier survival curve was used to estimate the probabilities of overall and event-free survival. Statistical significance was set at p < 0.05. RESULTS A total of 92 children with AML were included in this study. The median age at diagnosis was 7 years (interquartile range: 5-10 years) with a slight male predominance. The median duration of symptoms was one month. Neutropenic fever (56, 86.2%) was the most common complication during treatment. About 29.3% of the patients succumbed to early death. The corresponding 1-year and 3-year OS probabilities were 28.2% and 23% respectively. The median event-free survival time for all pediatric AML patients was one-month (95% CI: 0.77-1.23). The determinants of poorer survival outcomes were FAB subtype, type of protocol used, and signs of CNS involvement (p < 0.05). CONCLUSION The survival rates of children from AML were low in the study setting. More than 25% of AML patients succumbed to early death, and febrile neutropenia was the most common complication. Effective supportive and therapeutic measures should be taken to manage febrile neutropenia and to prevent early death in AML patients.
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Affiliation(s)
- Wudinesh Mamo
- Pediatrician and Child Health Specialist, Addis Ababa, Ethiopia
| | - Ayalew Moges
- Department of Pediatrics and Child Health, School of Medicine, Addis Ababa University, P.O. Box 9080, Addis Ababa, Ethiopia
| | - Subah Abderehim Yesuf
- Department of Family Medicine, St. Peter Specialized Hospital, Addis Ababa, Ethiopia
| | - Abdulkadir Mohamedsaid
- Department of Pediatrics and Child Health, School of Medicine, Addis Ababa University, P.O. Box 9080, Addis Ababa, Ethiopia
| | - Gashaw Arega
- Department of Pediatrics and Child Health, School of Medicine, Addis Ababa University, P.O. Box 9080, Addis Ababa, Ethiopia.
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3
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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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4
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Chianese U, Papulino C, Megchelenbrink W, Tambaro FP, Ciardiello F, Benedetti R, Altucci L. Epigenomic machinery regulating pediatric AML: clonal expansion mechanisms, therapies, and future perspectives. Semin Cancer Biol 2023; 92:84-101. [PMID: 37003397 DOI: 10.1016/j.semcancer.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/07/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023]
Abstract
Acute myeloid leukemia (AML) is a heterogeneous disease with a genetic, epigenetic, and transcriptional etiology mainly presenting somatic and germline abnormalities. AML incidence rises with age but can also occur during childhood. Pediatric AML (pAML) accounts for 15-20% of all pediatric leukemias and differs considerably from adult AML. Next-generation sequencing technologies have enabled the research community to "paint" the genomic and epigenomic landscape in order to identify pathology-associated mutations and other prognostic biomarkers in pAML. Although current treatments have improved the prognosis for pAML, chemoresistance, recurrence, and refractory disease remain major challenges. In particular, pAML relapse is commonly caused by leukemia stem cells that resist therapy. Marked patient-to-patient heterogeneity is likely the primary reason why the same treatment is successful for some patients but, at best, only partially effective for others. Accumulating evidence indicates that patient-specific clonal composition impinges significantly on cellular processes, such as gene regulation and metabolism. Although our understanding of metabolism in pAML is still in its infancy, greater insights into these processes and their (epigenetic) modulation may pave the way toward novel treatment options. In this review, we summarize current knowledge on the function of genetic and epigenetic (mis)regulation in pAML, including metabolic features observed in the disease. Specifically, we describe how (epi)genetic machinery can affect chromatin status during hematopoiesis, leading to an altered metabolic profile, and focus on the potential value of targeting epigenetic abnormalities in precision and combination therapy for pAML. We also discuss the possibility of using alternative epidrug-based therapeutic approaches that are already in clinical practice, either alone as adjuvant treatments and/or in combination with other drugs.
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Affiliation(s)
- Ugo Chianese
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
| | - Chiara Papulino
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
| | - Wout Megchelenbrink
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy; Princess Máxima Center, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands.
| | - Francesco Paolo Tambaro
- Bone Marrow Transplant Unit, Pediatric Oncology Department AORN Santobono Pausilipon, 80129, Naples Italy.
| | - Fortunato Ciardiello
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
| | - Rosaria Benedetti
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
| | - Lucia Altucci
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy; Biogem Institute of Molecular and Genetic Biology, 83031 Ariano Irpino, Italy; IEOS, Institute for Endocrinology and Oncology "Gaetano Salvatore" (IEOS), 80131 Naples, Italy.
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5
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Roy PS, Munikoty V, Trehan A, Jain R, Bhatia P, Naseem S, Varma N, Bansal D. Early mortality continues to be a barrier to excellent survival in childhood acute promyelocytic leukemia: a retrospective study of 62 patients spanning 17 years. Pediatr Hematol Oncol 2023; 40:117-130. [PMID: 35849424 DOI: 10.1080/08880018.2022.2082610] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Data on childhood acute promyelocytic leukemia (APL) from low-and middle-income countries is limited. Early mortality is a concern and often not highlighted in clinical trials. The retrospective study was conducted on patients (≤12 years) with APL from 2003 to 2021 at a single center in India. Patients were treated with all-trans-retinoic acid (ATRA) and chemotherapy. Induction and three courses of consolidation were followed by maintenance for 2 years. In 2015, the protocol was updated with following modifications: (a) obtaining diagnostic cerebrospinal fluid at end-of-induction rather than at diagnosis, (b) administering intrathecal cytarabine regardless of risk-category, (c) risk-stratified administration of chemotherapy, and (d) inclusion of ATRA in all the cycles of consolidation. Sixty-two patients were diagnosed over the 17 years. The median age was 8 years (range: 0.9-12). Half had high-risk disease. Differentiation syndrome was observed in 32%, none being fatal. Eighteen (29%) patients died due to hemorrhage (83%) or septicemia (17%). Thirteen (21%) had early mortality (≤15 days), all due to hemorrhage. A platelet count <20 × 109/L predicted early mortality (odds ratio: 4.5; 95% CI: 0.9-22, p = 0.06). Treatment abandonment reduced from 23.5% during 2003-2015 to nil during 2015-2021 (p = 0.006). Three (8%) patients relapsed. The 4-year OS of all patients and the patients who survived >15 days was 70.1% and 89.6%, respectively. The 4-year EFS, including abandonment and early mortality, before and following updated protocol, was 61.4% and 65.5%, respectively (p = 0.77). Early mortality continues to be a barrier to an otherwise excellent survival in childhood APL. A significant reduction in treatment abandonment in recent years is gratifying.
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Affiliation(s)
- Pritam Singha Roy
- Department of Pediatrics, Advanced Pediatrics Center, Hematology-Oncology Unit, Chandigarh, India
| | - Vinay Munikoty
- Department of Pediatrics, Advanced Pediatrics Center, Hematology-Oncology Unit, Chandigarh, India
| | - Amita Trehan
- Department of Pediatrics, Advanced Pediatrics Center, Hematology-Oncology Unit, Chandigarh, India
| | - Richa Jain
- Department of Pediatrics, Advanced Pediatrics Center, Hematology-Oncology Unit, Chandigarh, India
| | - Prateek Bhatia
- Department of Pediatrics, Advanced Pediatrics Center, Hematology-Oncology Unit, Chandigarh, India
| | - Shano Naseem
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neelam Varma
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Bansal
- Department of Pediatrics, Advanced Pediatrics Center, Hematology-Oncology Unit, Chandigarh, India
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6
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Pediatric Acute Myeloid Leukemia—Past, Present, and Future. J Clin Med 2022; 11:jcm11030504. [PMID: 35159956 PMCID: PMC8837075 DOI: 10.3390/jcm11030504] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/31/2021] [Accepted: 01/13/2022] [Indexed: 02/06/2023] Open
Abstract
This review reports about the main steps of development in pediatric acute myeloid leukemia (AML) concerning diagnostics, treatment, risk groups, and outcomes. Finally, a short overview of present and future approaches is given.
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Oigman G, Osorio DS, Ferman S, Stanek JR, Aversa do Souto A, Christiani MMC, Magalhaes DMA, Finlay JL, Vianna DA. Epidemiological characteristics and survival outcomes of children with medulloblastoma treated at the National Cancer Institute (INCA) in Rio de Janeiro, Brazil. Pediatr Blood Cancer 2022; 69:e29274. [PMID: 34767315 DOI: 10.1002/pbc.29274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Medulloblastoma (MB),the most common malignant brain tumor of childhood has survival outcomes exceeding 80% for standard-risk and 60% for high-risk patients in high-income countries (HICs). These results have not been replicated in low- and middle-income countries (LMICs), where 80% of children with cancer live. METHODS This is a retrospective review of 114 children aged 3-18 years diagnosed with MB from 1997 to 2016 at National Cancer Institute (INCA). Sociodemographic, clinical, and treatment data were extracted from the medical records and summarized descriptively. Overall survival (OS) and progression-free survival (PFS) were calculated using the Kaplan-Meier method. RESULTS The male-to-female ratio was 1.32 and the median age at diagnosis was 8.2 years. Headache (83%) and nausea/vomiting (78%) were the most common presenting symptoms. Five-year OS was 59.1% and PFS was 58.4%. The OS for standard-risk and high-risk patients was 69% and 53%, respectively. The median time to diagnosis interval was 50.5 days and the median time from surgery to radiation therapy initiation was 50.4 days. Patients who lived >40 km from INCA fared better (OS = 68.2% vs. 51.1%, p = .032). Almost 20% of families lived below the Brazilian minimum wage. Forty-five patients (35%) had metastatic disease at admission. Gross total resection was achieved in 57% of the patitents. CONCLUSIONS Although there are considerable barriers to deliver effective MB treatment in countries like Brazil, the OS seen in the present study demonstrates that good outcomes are not only feasible but can and should be increased with appropriate interventions.
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Affiliation(s)
- Gabriela Oigman
- Division of Pediatric Oncology, National Cancer Institute, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Diana S Osorio
- Division of Hematology, Oncology, and BMT, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | - Sima Ferman
- Division of Pediatric Oncology, National Cancer Institute, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Joseph R Stanek
- Division of Hematology, Oncology, and BMT, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | | | - Marcio M C Christiani
- Division of Neurosurgery, National Cancer Institute, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Denise M A Magalhaes
- Division of Radiation Oncology, National Cancer Institute, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jonathan L Finlay
- Division of Hematology, Oncology, and BMT, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | - Denizar A Vianna
- Internal Medicine Department, State University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
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8
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van Weelderen RE, Njuguna F, Klein K, Mostert S, Langat S, Vik TA, Olbara G, Kipng'etich M, Kaspers GJL. Outcomes of pediatric acute myeloid leukemia treatment in Western Kenya. Cancer Rep (Hoboken) 2021; 5:e1576. [PMID: 34811958 PMCID: PMC9575503 DOI: 10.1002/cnr2.1576] [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: 06/14/2021] [Revised: 08/13/2021] [Accepted: 09/28/2021] [Indexed: 12/04/2022] Open
Abstract
Background Pediatric acute myeloid leukemia (AML) is a challenging disease to treat in low‐ and middle‐income countries (LMICs). Literature suggests that survival in LMICs is poorer compared with survival in high‐income countries (HICs). Aims This study evaluates the outcomes of Kenyan children with AML and the impact of sociodemographic and clinical characteristics on outcome. Methods and Results A retrospective medical records study was performed at Moi Teaching and Referral Hospital (MTRH) in Eldoret, Kenya, between January 2010 and December 2018. Sociodemographic and clinical characteristics, and treatment outcomes were evaluated. Chemotherapy included two “3 + 7” induction courses with doxorubicin and cytarabine and two “3 + 5” consolidation courses with etoposide and cytarabine. Supportive care included antimicrobial prophylaxis with cotrimoxazole and fluconazole, and blood products, if available. Seventy‐three children with AML were included. The median duration of symptoms before admission at MTRH was 1 month. The median time from admission at MTRH to diagnosis was 6 days and to the start of AML treatment 16 days. Out of the 55 children who were started on chemotherapy, 18 (33%) achieved complete remission, of whom 10 (56%) relapsed. The abandonment rate was 22% and the early death rate was 46%. The 2‐year probabilities of event‐free survival and overall survival were 4% and 7%, respectively. None of the sociodemographic and clinical characteristics were significantly associated with outcome. Conclusion Survival of Kenyan children with AML is dismal and considerably lower compared with survival in HICs. Strategies to improve survival should be put in place including better supportive care, optimization of the treatment protocol, and reduction of the abandonment rate and time lag to diagnosis with sooner start of treatment.
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Affiliation(s)
- Romy E van Weelderen
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Festus Njuguna
- Child Health and Pediatrics, Moi University/Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Kim Klein
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - Saskia Mostert
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Sandra Langat
- Child Health and Pediatrics, Moi University/Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Terry A Vik
- Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Gilbert Olbara
- Child Health and Pediatrics, Moi University/Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Martha Kipng'etich
- Child Health and Pediatrics, Moi University/Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Gertjan J L Kaspers
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Elyamany G, Akhter A, Kamran H, Rizwan H, Shabani-Rad MT, Alkhayat N, Al Sharif O, Elborai Y, Al Shahrani M, Mansoor A. Gene Expression Analysis of Pediatric Acute Myeloid Leukemia Identified a Hyperactive ASXL1/BAP1 Axis Linked with Poor Prognosis and over Expressed Epigenetic Modifiers. Pediatr Hematol Oncol 2021; 38:581-592. [PMID: 33764257 DOI: 10.1080/08880018.2021.1901808] [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
Genetic aberrations in the epigenome are rare in pediatric AML, hence expression data in epigenetic regulation and its downstream effect is lacking in childhood AML. Our pilot study screened epigenetic modifiers and its related oncogenic signal transduction pathways concerning clinical outcomes in a small cohort of pediatric AML in KSA. RNA from diagnostic BM biopsies (n = 35) was subjected to expression analysis employing the nCounter Pan-Cancer pathway panel. The patients were dichotomized into low ASXL1 (17/35; 49%) and high ASXL1 (18/35; 51%) groups based on ROC curve analysis. Age, gender, hematological data or molecular risk factors (FLT3 mutation/molecular fusion) exposed no significant differences across these two distinct ASXL1 expression groups (P > 0.05). High ASXL1 expression showed linkage with high expression of other epigenetic modifiers (TET2/EZH2/IDH1&2). Our data showed that high ASXL1 mRNA is interrelated with increased BRCA1 associated protein-1 (BAP1) and its target gene E2F Transcription Factor 1 (E2F1) expression. High ASXL1 expression was associated with high mortality {10/18 (56%) vs. 1/17; (6%) P < 0 .002}. Low ASXL1 expressers showed better OS {740 days vs. 579 days; log-rank P= < 0.023; HR 7.54 (0.98-54.1)}. The association between high ASXL1 expression and epigenetic modifiers is interesting but unexplained and require further investigation. High ASXL1 expression is associated with BAP1 and its target genes. Patients with high ASXL1 expression showed poor OS without any association with a conventional molecular prognostic marker.
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Affiliation(s)
- Ghaleb Elyamany
- Department of Central Military Laboratory and Blood Bank, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ariz Akhter
- Department of Pathology and Laboratory Medicine, University of Calgary/Alberta Precision Laboratories (APL), Alberta, Canada
| | - Hamza Kamran
- Department of Pathology and Laboratory Medicine, University of Calgary/Alberta Precision Laboratories (APL), Alberta, Canada
| | - Hassan Rizwan
- Department of Pathology and Laboratory Medicine, University of Calgary/Alberta Precision Laboratories (APL), Alberta, Canada
| | - Meer-Taher Shabani-Rad
- Department of Pathology and Laboratory Medicine, University of Calgary/Alberta Precision Laboratories (APL), Alberta, Canada
| | - Nawaf Alkhayat
- Division of Pediatric Hematology/Oncology, Department of Pediatric, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Omar Al Sharif
- Division of Pediatric Hematology/Oncology, Department of Pediatric, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Yasser Elborai
- Division of Pediatric Hematology/Oncology, Department of Pediatric, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.,Department of Pediatric Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mohammad Al Shahrani
- Division of Pediatric Hematology/Oncology, Department of Pediatric, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Adnan Mansoor
- Department of Pathology and Laboratory Medicine, University of Calgary/Alberta Precision Laboratories (APL), Alberta, Canada
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10
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Minimally myelosuppressive regimen for remission induction in pediatric AML: long-term results of an observational study. Blood Adv 2021; 5:1837-1847. [PMID: 33787864 DOI: 10.1182/bloodadvances.2020003453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 02/16/2021] [Indexed: 11/20/2022] Open
Abstract
Treatment refusal and death as a result of toxicity account for most treatment failures among children with acute myeloid leukemia (AML) in resource-constrained settings. We recently reported the results of treating children with AML with a combination of low-dose cytarabine and mitoxantrone or omacetaxine mepesuccinate with concurrent granulocyte colony-stimulating factor (G-CSF) (low-dose chemotherapy [LDC]) for remission induction followed by standard postremission strategies. We have now expanded the initial cohort and have provided long-term follow-up. Eighty-three patients with AML were treated with the LDC regimen. During the study period, another 100 children with AML received a standard-dose chemotherapy (SDC) regimen. Complete remission was attained in 88.8% and 86.4% of patients after induction in the LDC and SDC groups, respectively (P = .436). Twenty-two patients in the LDC group received SDC for the second induction course. Significantly more high-risk AML patients were treated with the SDC regimen (P = .035). There were no significant differences between the LDC and SDC groups in 5-year event-free survival (61.4% ± 8.7% vs 65.2% ± 7.4%, respectively; P = .462), overall survival (72.7% ± 6.9% vs 72.5% ± 6.2%, respectively; P = .933), and incidence of relapse (20.5% ± 4.5% vs 17.6% ± 3.9%, respectively; P = .484). Clearance of mutations based on the average variant allele frequency at complete remission in the LDC and SDC groups was 1.9% vs 0.6% (P < .001) after induction I and 0.17% vs 0.078% (P = .052) after induction II. In conclusion, our study corroborated the high remission rate reported for children with AML who received at least 1 course of LDC. The results, although preliminary, also suggest that long-term survival of these children is comparable to that of children who receive SDC regimens.
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11
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Hoch REE, Cóser VM, Santos IS, de Souza APD. Lymphoid markers predict prognosis of pediatric and adolescent acute myeloid leukemia. Leuk Res 2021; 107:106603. [PMID: 33957373 DOI: 10.1016/j.leukres.2021.106603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/24/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022]
Abstract
Acute Myeloid Leukemia (AML) is a complex and highly aggressive disease. To characterize the prognostic factors of pediatric patients with AML relapse, a retrospective cohort study was performed to collect data from children and adolescents, at a hematological oncology reference center, over 11 years. We selected 51 cases of the disease, diagnosed and treated uniformly, divided into two groups: with complete remission (n = 33; 65 %) and with relapse (n = 18; 35 %). The groups were homogeneous concerning demographic characteristics and hematological parameters at diagnosis. AML M3 was the most common subtype (n = 19; 37 %) and was associated with a good prognosis. The highest rate of relapse was with AML M0 (n = 3 of 5 patients; 60 %). The most predominant gene mutation, FLT3-ITD, did not influence the prognosis in our study. The complete remission group presented a higher mean frequency of positive cells for the granulocytic marker CD13a at diagnosis. In cases with AML relapse, CD36, CD4, CD7, and CD22 were the most expressed markers. Increase incidence of recurrence was associated with CD7 (HR 1.035; p = 0.003), CD4 (HR 1.032, p = 0.001) and CD22 (HR 1.042; p = 0.049). Our results highlight the importance of analyzing immunophenotypic markers to help predict the outcome of AML in children and adolescents.
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Affiliation(s)
- Rosméri Elaine Essy Hoch
- Laboratory of Clinical and Experimental Immunology, Healthy and Life Science School Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Hematology-Oncology Unit, University Hospital of Santa Maria, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | - Virgínia Maria Cóser
- Hematology-Oncology Unit, University Hospital of Santa Maria, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | - Iná S Santos
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil; Post-Graduate Program in Pediatrics and Child Health, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Ana Paula Duarte de Souza
- Laboratory of Clinical and Experimental Immunology, Healthy and Life Science School Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
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12
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Prognostic Significance of CD56 Antigen Expression in Patients with De Novo Non-M3 Acute Myeloid Leukemia. BIOMED RESEARCH INTERNATIONAL 2021; 2021:1929357. [PMID: 33928145 PMCID: PMC8049794 DOI: 10.1155/2021/1929357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 02/02/2021] [Accepted: 03/20/2021] [Indexed: 01/18/2023]
Abstract
Acute myeloid leukemia (AML) is a heterogeneous group of disorders with distinct characteristics and prognoses. Although cytogenetic changes and gene mutations are associated with AML prognosis, there is a need to identify further factors. CD56 is considered a prognostic factor for AML, which is abnormally expressed in leukemia cells. However, a clear consensus for this surface molecule is lacking, which has prompted us to investigate its prognostic significance. Bone marrow samples of de novo non-M3 AML were collected to detect CD56 expression using multiparameter flow cytometry (FCM). As a result, the CD56 expression in de novo non-M3 AML was found to be significantly higher than that in acute lymphoma leukemia (ALL, P = 0.017) and healthy controls (P = 0.02). The X-Tile program produced a CD56 cutoff point at a relative expression level of 24.62%. Based on this cutoff point, high CD56 expression was observed in 29.21% of de novo non-M3 AML patients. CD56-high patients had a poor overall survival (OS, P = 0.015) compared to CD56-low patients. Bone marrow transplantation (BMT) improved OS (P = 0.004), but a poor genetic risk was associated with an inferior OS (P = 0.002). Compared with CD56-low patients, CD56-high patients had lower peripheral blood platelet (PLT) counts (P = 0.010). Our research confirmed that high CD56 expression is associated with adverse clinical outcomes in de novo non-M3 AML patients, indicating that CD56 could be used as a prognostic marker for a more precise stratification of de novo non-M3 AML patients.
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13
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Chen W, Yang J, Chen P. Cytogenetic characteristics of and prognosis for acute myeloid leukemia in 107 children. ASIAN BIOMED 2021; 15:79-89. [PMID: 37551405 PMCID: PMC10388776 DOI: 10.2478/abm-2021-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Patients diagnosed with acute myeloid leukemia (AML) in childhood have a poor prognosis. A better understanding of prognostic factors will assist patients and clinicians in making difficult treatment decisions. Objectives To understand further the cytogenetic characteristics of and reassess the prognostic value of cytogenetic abnormalities in childhood AML. Methods Conventional karyotypes of 107 children with AML were analyzed retrospectively. The cases were divided into 4 groups based on genetic rearrangements; namely patients with: t(15;17)/PML-RARA; t(8;21)/RUNX1-RUNX1T1 or inv(16)(p13;q22) and t(16;16)/CBFB-MYH11; -7 or complex karyotypes; normal karyotypes or other cytogenetic changes. Differences in age, sex, leukocyte count, event-free survival (EFS), and overall survival (OS) were analyzed. Results All French-American-British (FAB) subtypes of AML were detected in 107 patients. We successfully cultured 81 of 107 bone marrow specimens, of which 60 cases had abnormal karyotypes. The most common abnormal karyotypes were t(8;21) (17/81 cases), followed by t(15;17) (13/81 cases), -X/Y (10/81 cases). There were no significant differences (P > 0.05) in age, sex, or leukocyte counts between the 4 groups. The differences in 3-year EFS and OS between each pair were significant, except for groups of patients with t(8;21)/RUNX1-RUNX1T1 and patients with normal karyotypes or other cytogenetic changes (P = 0.054). Conclusions Chromosomal abnormalities may provide important prognostic factors for AML in children and be helpful for risk stratification and individual treatment.
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Affiliation(s)
- Wanzi Chen
- Department of Hematology, Fujian Medical University Union Hospital, Fuzhou, Fujian350001, China
| | - Jinghui Yang
- Fujian Provincial Key Laboratory on Hematology, Fujian Institute of Hematology, Fujian Medical University Union Hospital, Fuzhou, Fujian350001, China
| | - Ping Chen
- Department of Pediatric Hematology, Fujian Medical University Union Hospital, Fuzhou, Fujian350001, China
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14
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Van Weelderen RE, Klein K, Natawidjaja MD, De Vries R, Kaspers GJ. Outcome of pediatric acute myeloid leukemia (AML) in low- and middle-income countries: a systematic review of the literature. Expert Rev Anticancer Ther 2021; 21:765-780. [PMID: 33779466 DOI: 10.1080/14737140.2021.1895756] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Survival rates of pediatric acute myeloid leukemia (AML) in low- and middle-income countries (LMICs) seem extremely poor, and the available literature on the matter is scarce. Accordingly, there is a limited understanding of poor treatment outcomes seen in this population.Areas covered: We provide an overview of the available literature with respect to treatment outcomes of pediatric AML in LMICs yielding poor outcomes compared to high-income countries. Moreover, treatment outcomes vary markedly between LMICs. In addition, there is a wide variation among studies in how treatment outcomes are reported and analyzed.Expert opinion: The substantially inferior treatment outcomes of pediatric AML in LMICs emphasize the unprecedented importance of global initiatives and international collaborations to improve the survival of these patients. A coordinated approach is necessary to carry out country-specific situational analyses. These analyses will result in operational plans on how to structurally implement childhood cancer registries, align healthcare infrastructure, build on capacities, and provide universal health coverage in LMICs. In addition, we strongly recommend that, in the future, LMICs document, analyze, and publish pediatric AML treatment outcomes in a more structured and uniform manner.
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Affiliation(s)
- Romy E Van Weelderen
- Emma Children's Hospital, Amsterdam UMC, Pediatric Oncology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Kim Klein
- Emma Children's Hospital, Amsterdam UMC, Pediatric Oncology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, the Netherlands
| | - Meyrina D Natawidjaja
- Emma Children's Hospital, Amsterdam UMC, Pediatric Oncology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ralph De Vries
- Medical Library, Vrije Universiteit, Amsterdam, the Netherlands
| | - Gertjan Jl Kaspers
- Emma Children's Hospital, Amsterdam UMC, Pediatric Oncology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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15
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de Melo Rodrigues AL, Bonfim C, Seber A, Colturato VAR, Zecchin VG, Nichele S, Daudt LE, Fernandes JF, Vieira AK, Darrigo Junior LG, Gomes AA, Arcuri L, Lenzi L, Picharski GL, Ribeiro RC, de Figueiredo BC. Allogeneic Hematopoietic Stem Cell Transplantation for Children and Adolescents with Acute Myeloid Leukemia in Brazil: A Multicentric Retrospective Study. Cell Transplant 2020; 29:963689720949175. [PMID: 32787568 PMCID: PMC7563924 DOI: 10.1177/0963689720949175] [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] [Indexed: 11/16/2022] Open
Abstract
The survival rates of children with high-risk acute myeloid leukemia (AML)
treated with hematopoietic stem cell transplant (HSCT) range from 60% to 70% in
high-income countries. The corresponding rate for Brazilian children with AML
who undergo HSCT is unknown. We conducted a retrospective analysis of 114
children with AML who underwent HSCT between 2008 and 2012 at institutions
participating in the Brazilian Pediatric Bone Marrow Transplant Working Group.
At transplant, 38% of the children were in first complete remission (CR1), 37%
were in CR2, and 25% were in CR3+ or had persistent disease. The donors included
49 matched-related, 59 matched-unrelated, and six haploidentical donors. The
most frequent source of cells was bone marrow (69%), followed by the umbilical
cord (19%) and peripheral blood (12%). The 4-year overall survival was 47% (95%
confidence interval [CI] 30%–57%), and the 4-year progression-free survival was
40% (95% CI 30%–49%). Relapse occurred in 49 patients, at a median of 122 days
after HSCT. There were 65 deaths: 40 related to AML, 19 to infection, and six to
graft versus host disease. In conclusion, our study suggests that HSCT outcomes
for children with AML in CR1 or CR2 are acceptable and that this should be
considered in the overall treatment planning for children with AML in Brazil.
Therapeutic standardization through the adoption of multicentric protocols and
appropriate supportive care treatment will have a significant impact on the
results of HSCT for AML in Brazil and possibly in other countries with limited
resources.
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Affiliation(s)
- Ana Luiza de Melo Rodrigues
- 245143Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, Paraná,Brazil.,245067Faculdades Pequeno Príncipe, Curitiba, Paraná, Brazil.,176853Hospital Pequeno Príncipe, Rua Desembargador Motta, Curitiba, Paraná, Brazil
| | - Carmem Bonfim
- 176853Hospital Pequeno Príncipe, Rua Desembargador Motta, Curitiba, Paraná, Brazil.,Hospital de Clínicas da 28122Universidade Federal do Paraná, Rua General Carneiro, Curitiba, Paraná, Brazil.,417434Hospital Nossa Senhora das Graças Rua Alcídes Munhoz, Curitiba, Paraná, Brazil
| | - Adriana Seber
- 125211Hospital Samaritano, Rua Conselheiro Brotero, Higienópolis, São Paulo, Brazil
| | | | | | - Samantha Nichele
- Hospital de Clínicas da 28122Universidade Federal do Paraná, Rua General Carneiro, Curitiba, Paraná, Brazil.,417434Hospital Nossa Senhora das Graças Rua Alcídes Munhoz, Curitiba, Paraná, Brazil
| | - Liane Esteves Daudt
- 37895Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, Santa Cecilia, Porto Alegre, Rio Grande do Sul, Brazil
| | - Juliana Folloni Fernandes
- Instituto de Tratamento do Câncer Infantil Hospital de Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Galeno de Almeida, Pinheiros, São Paulo, Brazil.,37896Hospital Israelita Albert Einstein, Jardim Leonor, São Paulo, Brazil
| | - Ana Karine Vieira
- Hospital de Clínicas da Univerdidade Federal de Minas Gerais Rua Prof. Alfredo Balena, Santa Efigenia, Belo Horizonte, Minas Gerais, Brazil
| | - Luiz Guilherme Darrigo Junior
- 54539Hospital de Clínicas da Faculdade de Medicina da Universidade de São Paulo- Ribeirão Preto, Campus Universitário, Vila Monte Alegre, Ribeirão Preto, São Paulo, Brazil
| | - Alessandra Araujo Gomes
- Instituto de Tratamento do Câncer Infantil Hospital de Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Galeno de Almeida, Pinheiros, São Paulo, Brazil.,42522Hospital Sírio Libanês, Rua Dona Adma Jafet, Bela Vista, São Paulo, Brazil
| | - Leonardo Arcuri
- Department of Oncology and Global Pediatric Medicine, 5417St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Luana Lenzi
- Departamento de Análises Clínicas, 28122Universidade Federal do Paraná, Jardim Botanico, Curitiba, Paraná, Brazil
| | | | - Raul Correa Ribeiro
- Department of Oncology and Global Pediatric Medicine, 5417St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Bonald Cavalcante de Figueiredo
- 245143Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, Paraná,Brazil.,245067Faculdades Pequeno Príncipe, Curitiba, Paraná, Brazil.,Centro de Genética Molecular e Pesquisa do Câncer em Crianças (CEGEMPAC) at 28122Universidade Federal do Paraná, Curitiba, Paraná, Brazil.,Departamento de Saúde Coletiva, 28122Universidade Federal do Paraná, Rua Padre Camargo, Curitiba, Paraná, Brazil
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16
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Ghafoor T, Khalil S, Farah T, Ahmed S, Sharif I. Prognostic Factors in Childhood Acute Myeloid Leukemia; Experience from A Developing Country. Cancer Rep (Hoboken) 2020; 3:e1259. [PMID: 33085844 DOI: 10.1002/cnr2.1259] [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] [Received: 02/05/2020] [Revised: 05/13/2020] [Accepted: 05/18/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND In the developed world, 5-years survival of childhood acute myeloid leukaemia (AML) has improved to 70%. However, the survival rates in the developing world are below 40%. The main contributing factors to these reduced survival rates are a late presentation, malnutrition and high treatment-related mortality. AIM To document the factors affecting treatment outcome of childhood AML at a tertiary care facility of Pakistan. METHODS AND RESULTS All newly registered cases of AML under 18 years of age from January 1, 2012 onwards who completed their treatment before November 30, 2019 were included. Data of 219 cases of AML containing 140 (63.9%) males and 79 (36.1%) females was analyzed. The mean age was 6.30 ± 3.66 years. Pallor was the commonest presenting features in 180 (82.2%) and M2 was the commonest French American-British (FAB) subtype in 103 (47.0%) cases. In univariate analysis, high white blood cells (WBC) count at presentation (P = .006), poor nutritional status (P = .005), unfavourable cytogenetics (P = .019), certain types of FAB AML subtype (P = .005), and use of etoposide in induction chemotherapy (P = .042) significantly adversely affected overall survival (OS). Neutropenic sepsis and bleeding were the major causes of treatment-related mortality. Response to induction chemotherapy was the most significant prognostic factor in the multivariate analysis (P = <.001). After a median follow-up of 40.96 ± 26.23 months, 5-year OS and DFS of the cohort were 40.6% and 38.3% respectively. CONCLUSIONS In this largest cohort of childhood AML from Pakistan, high WBC count at presentation, malnutrition, unfavourable cytogenetics and use of etoposide during induction chemotherapy were associated with decreased OS and DFS rates. Response to the induction chemotherapy was the most significant prognostic factor.
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Affiliation(s)
- Tariq Ghafoor
- Department of Paediatric Haematology, Armed Forces Bone Marrow Transplant Centre, CMH Medical Complex, Rawalpindi, Pakistan.,Department of Paediatric Oncology, Combined Military Hospital, Rawalpindi, Pakistan
| | - Sumaira Khalil
- Department of Paediatric Oncology, Combined Military Hospital, Rawalpindi, Pakistan
| | - Tanzeela Farah
- Department of Paediatric Oncology, Combined Military Hospital, Rawalpindi, Pakistan
| | - Shakeel Ahmed
- Department of Paediatric Oncology, Combined Military Hospital, Rawalpindi, Pakistan
| | - Imtenan Sharif
- Department of Community medicine, National University of Medical Sciences, Rawalpindi, Pakistan
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