1
|
Correa BT, Silva GSS, Mendes WJS, Maia ADM, Aleluia ACM, Fonseca TCC, da Guarda CC, Gonçalves MDS, Aleluia MM. Association of the clinical profile and overall survival of pediatric patients with acute lymphoblastic leukemia. Front Pediatr 2023; 11:1223889. [PMID: 37744444 PMCID: PMC10513176 DOI: 10.3389/fped.2023.1223889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/25/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction The clarification of etiopathology, the improvement of chemotherapy regimens and their risk stratifications, and the improvement in treatment support have increased the survival of children and adolescents affected by Acute Lymphoblastic Leukemia (ALL) past few years. This study aimed to estimate overall survival (OS) and event-free survival (EFS) in an onco-hematology treatment center in Brazil, reports the main clinical-laboratory characteristics of patients at diagnosis, verify the frequency of treatment-related adverse effects and the main causes of death. Material and methods Retrospective analysis involving patients diagnosed with ALL, treated with the protocol of the Brazilian Group for Treatment of Leukemias in Childhood (GBTLI), between 2010 and 2020 was carried out; the outcomes (relapse, deaths, development of new neoplasms) were analyzed SPSS® software was used for the statistical analyses, and the p-value was considered significant when less than 0.05 for all analyses. Results 109 patients were included in the study; the median age was 5 years, with a slight predominance of males. Sixty-six patients were classified as high-risk (HR) group and 43 patients were classified as low-risk (LR) group. After 5 years of diagnosis, the OS was 71.5%, and the EFS was 65%. No statistical difference was found between the HR and LR groups for OS and EFS, while leukocyte counts were statistically associated with the outcome of death (p = 0.028). Among the patients, 28 (25.6%) died due to infection accounting 46.4% of death causes. Among the 34 patients with unfavorable outcomes (death and/or relapse), 32 had no research for the minimal residual disease at the end of remission induction, and 25 were not investigated for the presence of chromosomal abnormalities. The most reported complications and treatment-related adverse effects were increased liver transaminases (85.9%), airway infection (79.4%), oral mucositis (67.2%), febrile neutropenia (64.4%), and diarrhea (36.4%). Conclusions The rates of OS and EFS obtained in this cohort are similar to those obtained in the few previous similar studies in Brazil and lower than those carried out in developed countries. The unavailability of prognostic tests may have hindered risk stratification and influenced the results obtained.
Collapse
Affiliation(s)
- Bruno Terra Correa
- Departamento de Ciências Biológicas, Laboratório de Patologia Aplicada e Genética, Universidade Estadual de Santa Cruz, Ilhéus, Bahia, Brasil
| | - Gabriela Sales Serra Silva
- Departamento de Ciências Biológicas, Laboratório de Patologia Aplicada e Genética, Universidade Estadual de Santa Cruz, Ilhéus, Bahia, Brasil
| | - Webert Joaquim Silva Mendes
- Departamento de Ciências Biológicas, Laboratório de Patologia Aplicada e Genética, Universidade Estadual de Santa Cruz, Ilhéus, Bahia, Brasil
| | | | - Augusto Cezar Magalhães Aleluia
- Departamento de Ciências Naturais, Universidade Estadual do Sudoeste da Bahia-Campus de Vitória da Conquista, Vitória da Conquista, Bahia, Brasil
| | | | - Caroline Conceição da Guarda
- Departamento de Ciências Biológicas, Laboratório de Patologia Aplicada e Genética, Universidade Estadual de Santa Cruz, Ilhéus, Bahia, Brasil
| | - Marilda de Souza Gonçalves
- Laboratório de Investigação Genética e Hematologia Translacional, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brasil
| | - Milena Magalhães Aleluia
- Departamento de Ciências Biológicas, Laboratório de Patologia Aplicada e Genética, Universidade Estadual de Santa Cruz, Ilhéus, Bahia, Brasil
| |
Collapse
|
2
|
Mendes-de-Almeida DP, Andrade FG, Sampaio Carvalho MDPS, Córdoba JC, Souza MDS, Neto PC, Spector LG, Pombo-de-Oliveira MS. Identifying childhood leukemia with an excess of hematological malignancies in first-degree relatives in Brazil. Front Oncol 2023; 13:1207695. [PMID: 37416530 PMCID: PMC10322205 DOI: 10.3389/fonc.2023.1207695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/23/2023] [Indexed: 07/08/2023] Open
Abstract
Background Familial aggregation in childhood leukemia is associated with epidemiological and genomic factors. Albeit epidemiological studies on the familial history of hematological malignancies (FHHMs) are scarce, genome-wide studies have identified inherited gene variants associated with leukemia risk. We revisited a dataset of acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) patients to explore the familial aggregation of malignancies among their relatives. Methods A series of 5,878 childhood leukemia (≤21 years of age) from the EMiLI study (2000-2019) were assessed. Lack of well-documented familial history of cancer (FHC) and 670 cases associated with genetic phenotypic syndromes were excluded. Leukemia subtypes were established according to World Health Organization recommendations. Logistic regression-derived odds ratios (ORs) and 95% confidence intervals (CIs) were performed and adjusted by age as a continuous variable, where ALL was the reference group for AML and conversely. The pedigree of 18 families with excess hematological malignancy was constructed. Results FHC was identified in 472 of 3,618 eligible cases (13%). Ninety-six of the 472 patients (20.3%) had an occurrence of FHHMs among relatives. Overall, FHC was significantly associated with AML (OR, 1.36; 95% CI, 1.01-1.82; p = 0.040). Regarding the first-degree relatives, the OR, 2.92 95% CI,1.57-5.42 and the adjOR, 1.16 (1.03-1.30; p0.001) were found for FHC and FHHM, respectively. Conclusion Our findings confirmed that AML subtypes presented a significant association with hematological malignancies in first-degree relatives. Genomic studies are needed to identify germline mutations that significantly increase the risk of developing myeloid malignancies in Brazil.
Collapse
Affiliation(s)
- Daniela P. Mendes-de-Almeida
- Department of Hematology, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
- Research Center, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States
| | | | | | - José Carlos Córdoba
- Department of Pediatric Hematology, Hospital da Criança de Brasília Jose Alencar, Brasília, Distrito Federal, Brazil
| | - Marcelo dos Santos Souza
- Department of Pediatric Hematology, Centro de Tratamento Oncológico e Hematológico Infantil - Hospital Regional Rosa Pedrossian (CETOHI-HRMS), Campo Grande, Mato Grosso do Sul, Brazil
| | - Paulo Chagas Neto
- Research Center, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil
| | - Logan G. Spector
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States
| | | |
Collapse
|
3
|
Andrade FG, Feliciano SVM, Sardou-Cezar I, Brisson GD, Dos Santos-Bueno FV, Vianna DT, Marques LVC, Terra-Granado E, Zalcberg I, Santos MDO, Costa JT, Noronha EP, Thuler LCS, Wiemels JL, Pombo-de-Oliveira MS. Pediatric Acute Promyelocytic Leukemia: Epidemiology, Molecular Features, and Importance of GST-Theta 1 in Chemotherapy Response and Outcome. Front Oncol 2021; 11:642744. [PMID: 33816294 PMCID: PMC8017304 DOI: 10.3389/fonc.2021.642744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/08/2021] [Indexed: 11/23/2022] Open
Abstract
Previous studies have suggested a variation in the incidence of acute promyelocytic leukemia (APL) among the geographic regions with relatively higher percentages in the Latin American population. We aimed to explore the population burden of pediatric APL, gathering information from the population-based cancer registry (PBCR) and the diagnosis of APL obtained through incident cases from a hospital-based cohort. The homozygous deletion in glutathione S-transferases (GSTs) leads to a loss of enzyme detoxification activity, possibly affecting the treatment response. Mutations in the RAS pathway genes are also considered to be a key component of the disease both in the pathogenesis and in the outcomes. We have assessed mutations in a RAS–MAP kinase pathway (FLT3, PTPN11, and K-/NRAS) and GST variant predisposition risk in the outcome. Out of the 805 children and adolescents with acute myeloid leukemia (AML) who are registered in the PBCR, 35 (4.3%) were APL cases. The age-adjusted incidence rate (AAIR) was 0.03 per 100,000 person-years. One-hundred and sixty-three patients with APL were studied out of 931 AML cases (17.5%) from a hospital-based cohort. Mutations in FLT3, KRAS, and NRAS accounted for 52.1% of the cases. Patients with APL presented a 5-year probability of the overall survival (OS) of 67.3 ± 5.8%. A GST-theta 1 (GSTT1) null genotype conferred adverse prognosis, with an estimated hazard ratio of 2.8, 95% confidence interval (CI) 1.2–6.9. We speculate that the GSTT1 polymorphism is associated with therapeutics and would allow better OS of patients with APL with a GSTT1 null genotype.
Collapse
Affiliation(s)
- Francianne G Andrade
- Pediatric Hematology-Oncology Program, Research Center, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Suellen V M Feliciano
- Pediatric Hematology-Oncology Program, Research Center, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Ingrid Sardou-Cezar
- Pediatric Hematology-Oncology Program, Research Center, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Gisele D Brisson
- Pediatric Hematology-Oncology Program, Research Center, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Filipe V Dos Santos-Bueno
- Pediatric Hematology-Oncology Program, Research Center, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Danielle T Vianna
- Laboratory of Molecular Biology, Bone Marrow Transplantation Center, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Luísa V C Marques
- Pediatric Hematology-Oncology Program, Research Center, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Eugênia Terra-Granado
- Pediatric Hematology-Oncology Program, Research Center, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Ilana Zalcberg
- Laboratory of Molecular Biology, Bone Marrow Transplantation Center, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Marceli de O Santos
- Surveillance and Prevention, Instituto Nacional de Cancer, Rio de Janeiro, Brazil
| | - Juliana T Costa
- Department of Pediatric Hematology-Oncology, Hospital Martagão Gesteira, Salvador, Brazil
| | - Elda P Noronha
- Pediatric Hematology-Oncology Program, Research Center, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Luiz C S Thuler
- Clinical Research Department, Research Center, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Joseph L Wiemels
- Center for Genetic Epidemiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Maria S Pombo-de-Oliveira
- Pediatric Hematology-Oncology Program, Research Center, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | | |
Collapse
|
4
|
Silva-Junior AL, Alves FS, Kerr MWA, Xabregas LA, Gama FM, Rodrigues MGA, Torres AS, Tarragô AM, Sampaio VS, Carvalho MPSS, Fraiji NA, Malheiro A, Costa AG. Acute lymphoid and myeloid leukemia in a Brazilian Amazon population: Epidemiology and predictors of comorbidity and deaths. PLoS One 2019; 14:e0221518. [PMID: 31437246 PMCID: PMC6705820 DOI: 10.1371/journal.pone.0221518] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 08/08/2019] [Indexed: 01/07/2023] Open
Abstract
Introduction Leukemia is the most common cancer in children and has the highest rates of incidence in industrialized countries, followed by developing countries. This epidemiologic profile can mainly be attributed to the availability of diagnostic resources. In Brazil, leukemia diagnosis is a challenge due to financial viability, lack of hemovigilance services in isolated regions and the vast size of the territory. Its incidence in the state of Amazonas has been increasing since 2010. Therefore, this study aims to describe the epidemiological pattern and spatial distribution of patients with acute lymphoid leukemia and acute myeloid leukemia in Amazonas and identify the predictors of comorbidity and death. Materials and methods A retrospective cross-sectional study was carried out based on patients’ data which was obtained from the database of a referral center for the period of 2005 to 2015. Variables included age, gender, ethnicity, civil status, schooling, income, location of residence, subtype of leukemia, comorbidities, and date of death. The spatial distribution was performed using QGIS v.2.18. Stata software was used for univariable and multivariable logistic regression to evaluate the association between both comorbidities and death for all characteristic groups of ALL and AML. Results The group that was studied was composed of 577 ALL and 266 AML patients. For both, most patients were male, with a schooling period of 1–4 years, received<1 minimum wage, and lived mostly in Manaus, followed by the municipality of Tefé. There was no association between the development of comorbidities and analyzed variables in patients with ALL. AML patients that were >60 years old and with family history of the disease had the highest risk of developing comorbidities (OR = 5.06, p = 0.038; OR = 2.44, p = 0.041, respectively). Furthermore, patients with ALL and in the 41-50-year age group had a higher risk of death (OR = 31.12; p = 0.001). No association between death and explanatory variables were found in patients with AML. In addition, significant difference was observed in time to death (chi2 = 4,098.32, p = 0.000), with 50% of patients with AML dying within two years after diagnosis, whereas in ALL, this percentual of death only is reached in approximately 5 years. Conclusion Our study describes the data of patients with acute leukemia in Amazonas, a remote region in the north of Brazil. In addition, it highlights the importance of hemovigilance in an Amazon region state, while focusing on peripheral areas which don't have prevention, diagnosis and treatment tools for this disease.
Collapse
Affiliation(s)
- Alexander Leonardo Silva-Junior
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas a Hematologia, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
| | - Fabíola Silva Alves
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas a Hematologia, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
| | - Marlon Wendell Athaydes Kerr
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas a Hematologia, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
| | - Lilyane Amorim Xabregas
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas a Hematologia, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
| | - Fábio Magalhães Gama
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas (UFAM), Manaus, AM, Brazil
| | - Maria Gabriela Almeida Rodrigues
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Amazonas, Brazil
| | - Alexandre Santos Torres
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
| | - Andréa Monteiro Tarragô
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas a Hematologia, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas (UFAM), Manaus, AM, Brazil
| | - Vanderson Souza Sampaio
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Amazonas, Brazil
- Fundação de Vigilância em Saúde do Amazonas, Manaus, Brazil
| | - Maria Perpétuo Socorro Sampaio Carvalho
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas a Hematologia, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
| | - Nelson Abrahim Fraiji
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas a Hematologia, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
| | - Adriana Malheiro
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas a Hematologia, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas (UFAM), Manaus, AM, Brazil
| | - Allyson Guimarães Costa
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas a Hematologia, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas (UFAM), Manaus, AM, Brazil
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Amazonas, Brazil
- * E-mail:
| |
Collapse
|
5
|
Lins MM, Santos MDO, de Albuquerque MDFPM, de Castro CCL, Mello MJG, de Camargo B. Incidence and survival of childhood leukemia in Recife, Brazil: A population-based analysis. Pediatr Blood Cancer 2017; 64. [PMID: 28000427 DOI: 10.1002/pbc.26391] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 11/05/2016] [Accepted: 11/10/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Leukemia is the most common pediatric cancer with incidence rates of around 48 per million for children under 15 years of age. The median age-adjusted incidence rate (AAIR) in children aged 0-14 years in Brazil is 53.3 per million. While overall survival rates for children with leukemia have improved significantly, data for incidence, trends, and relative survival among children and adolescents with leukemia in Recife, Brazil, remain incomplete, which hampers our analyses and provision of the best healthcare. The objective of this report is to provide that data. METHODS Data from the Population-Based Cancer Registry of Recife were analyzed from 1998 to 2007. Our analyses included frequencies and AAIR, together with age-specific incidence rates for all leukemias, acute lymphoblastic leukemia, and acute myeloid leukemia. To evaluate incidence trends, joinpoint regression, including annual average percent change, were analyzed. Relative survival was calculated using the life-table method. RESULTS One hundred seventy-five cases were identified, 51% in females. The review reduced the not otherwise specified (NOS) leukemia category by 50% and diagnosis by death certificate only from 5.7% to 1.1%. The AAIR for leukemia was 41.1 per million, with a peak among children aged 1-4 (78.3 per million). Incidence trends during the period were stable. The five-year relative survival rate was 69.8%. CONCLUSIONS These data represent the incidence rate and survival of childhood leukemia in Recife, located in the northeast region of Brazil, using a high-quality database.
Collapse
Affiliation(s)
- Mecneide Mendes Lins
- Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, PE, Brazil.,Instituto Nacional de Cancer, Rio de Janeiro, Brazil.,Pediatric Oncology Unit, Instituto de Medicina Integral Prof. Fernando Figueira-IMIP, Recife, PE, Brazil
| | - Marceli de Oliveira Santos
- Divisão de Vigilância e Análise de Situação Coordenação de Prevenção e Vigilância (Surveilance Division and Surveilance and Prevention Coordination Situation of Analysis) at Instituto Nacional do Câncer, Rio de Janeiro, Brazil
| | | | | | - Maria Julia Gonçalves Mello
- Pediatric Research Center, Instituto de Medicina Integral Prof. Fernando Figueira - IMIP, Recife, PE, Brazil
| | - Beatriz de Camargo
- Pediatric Hematology and Oncology Program, Research Center, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| |
Collapse
|
6
|
Pombo-de-Oliveira MS, Andrade FG. Early-age Acute Leukemia: Revisiting Two Decades of the Brazilian Collaborative Study Group. Arch Med Res 2017; 47:593-606. [PMID: 28476187 DOI: 10.1016/j.arcmed.2016.11.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 11/24/2016] [Indexed: 12/20/2022]
Abstract
The understanding of leukemogenesis in early-age acute leukemia (EAL) has improved remarkably. Initiating somatic mutations detected in dried neonatal blood spots (DNBS) and in cord blood samples of affected children with leukemia have been proven to be acquired prenatally. However, to date, few epidemiological studies have been carried out exploring EAL that include infants and children 13-24 months of age at the diagnosis. Maternal exposure to transplacental DNA-damaging substances during pregnancy has been suggested to be a risk factor for EAL. Most cases of infants with acute lymphoblastic (i-ALL) or myeloid leukemia (i-AML) have KMT2A gene rearrangements (KMT2A-r), which disturb its essential role as an epigenetic regulator of hematopoiesis. Due to the short latency period for EAL and the fact that KMT2A-r resembles those found in secondary AML, exposure to topoisomerase II inhibitors has been associated with transplacental risk as proxi for causality. EAL studies have been conducted in Brazil for over two decades, combining observational epidemiology, leukemia biology, and clinical data. EAL was investigated considering (i) age strata (infants vs. 13-24 months-old); (ii) somatic mutations associated with i-ALL and i-AML; (iii) ethnic-geographic variations; (iv) contribution of maternal genotypes; and (v) time latency of exposures and mutations in DNBS. Interactions of acquired and constitutive gene mutations are challenging tools to test risk factor associations for EAL. In this review we summarize the EAL scenario (including B-cell precursor-ALL, T-ALL, and AML) results combining environmental and genetic susceptibility risk factors and we raise questions that should be considered for further action.
Collapse
Affiliation(s)
- Maria S Pombo-de-Oliveira
- Pediatric Hematology-Oncology Research Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil.
| | - Francianne Gomes Andrade
- Pediatric Hematology-Oncology Research Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | -
- Pediatric Hematology-Oncology Research Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| |
Collapse
|
7
|
Molecular Characterization of Pediatric Acute Myeloid Leukemia: Results of a Multicentric Study in Brazil. Arch Med Res 2016; 47:656-667. [DOI: 10.1016/j.arcmed.2016.11.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 11/23/2016] [Indexed: 12/19/2022]
|
8
|
Andrade FG, Noronha EP, Baseggio RM, Fonseca TCC, Freire BMR, Quezado Magalhaes IM, Zalcberg IR, Pombo-de-Oliveira MS. Identification of the MYST3-CREBBP fusion gene in infants with acute myeloid leukemia and hemophagocytosis. Rev Bras Hematol Hemoter 2016; 38:291-297. [PMID: 27863755 PMCID: PMC5119666 DOI: 10.1016/j.bjhh.2016.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 06/07/2016] [Accepted: 06/16/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Acute myeloid leukemia presenting the MYST3-CREBBP fusion gene is a rare subgroup associated with hemophagocytosis in early infancy and monocytic differentiation. The aim of this study was to define the relevant molecular cytogenetic characteristics of a unique series of early infancy acute myeloid leukemia cases (≤24months old), based on the presence of hemophagocytosis by blast cells at diagnosis. METHODS A series of 266 infant cases of acute myeloid leukemia was the reference cohort for the present analysis. Acute myeloid leukemia cases with hemophagocytosis by blast cells were reviewed to investigate the presence of the MYST3-CREBBP fusion gene by fluorescence in situ hybridization (FISH) and reverse transcription polymerase chain reaction. RESULTS Eleven cases with hemophagocytosis were identified with hemophagocytic lymphohistiocytosis being ruled out. Six cases were classified as myelomonocytic leukemia, three as AML-M7 and two as AML-M2. In five cases, the presence of the MYST3-CREBBP fusion gene identified by molecular cytogenetics was confirmed by fluorescence in situ hybridization. All patients received treatment according to the Berlin-Frankfürt-Münster acute myeloid leukemia protocols and only one out of the five patients with the MYST3-CREBBP fusion gene is still alive. CONCLUSIONS Our findings demonstrate that the presence of hemophagocytosis in acute myeloid leukemia was not exclusively associated to the MYST3-CREBBP fusion gene. Improvements in molecular cytogenetics may help to elucidate more complex chromosomal rearrangements in infants with acute myeloid leukemia and hemophagocytosis.
Collapse
Affiliation(s)
| | | | - Rosania Maria Baseggio
- Hospital Regional do Mato Grosso do Sul Rosa Pedrossian (HRMS), Campo Grande, MS, Brazil
| | | | | | | | | | | |
Collapse
|
9
|
Reis RDS, Santos MDO, de Camargo B, Oliveira JFP, Thuler LCS, Pombo-de-Oliveira MS. Early childhood leukemia incidence trends in Brazil. Pediatr Hematol Oncol 2016; 33:83-93. [PMID: 26925506 DOI: 10.3109/08880018.2015.1130763] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Incidence rates of childhood leukemia vary between different regions of the world. The objective of this study was to test possible trends in incidence rate of early childhood leukemia (children <5 years old at the diagnosis) in Brazil. Data from 18 population-based cancer registries (PBCRs) were analyzed (period 1999-2010). The analysis consisted of frequencies, age-adjusted incidence rates, and joinpoint regression results, including annual average percent change (AAPC) in incidence rates and 95% confidence intervals (CIs). The median age-adjusted incidence rate (AAIR) of overall early childhood leukemia was 61 per million. The AAIR for acute lymphoid leukemia (ALL) was 44 per million and nonlymphoid acute leukemia (NLAL) was 14 per million. The median ALL/NLAL ratio was 3.0, suggesting higher incidence rate of NLAL in these settings. The joinpoint analysis demonstrated increased leukemia incidence rate in João Pessoa (AAPC = 20; 95% CI: 3.5, 39.4) and Salvador (AAPC = 8.68; 95% CI: 1.0, 16.9), respectively, whereas incidence rate in São Paulo PBCR decreased (AAPC = -4.02%; 95% CI: -6.1%, -1.9%). Correlation between ALL AAIR and selected variables of socioeconomic (SES) factors was not observed. Increased AAIR regionally overtime was observed. However, the interpretation for such phenomenon should be cautious because it might reflect the access to health care, diagnosis procedures, and improvement of PBCR´s quality. The observed trend supports the necessity of further ecological studies.
Collapse
Affiliation(s)
- Rejane de Souza Reis
- a Divisão de Vigilância e Análise de Situação Coordenação de Prevenção e Vigilância, Instituto Nacional do Câncer , Rio de Janeiro , Brazil
| | - Marceli de Oliveira Santos
- a Divisão de Vigilância e Análise de Situação Coordenação de Prevenção e Vigilância, Instituto Nacional do Câncer , Rio de Janeiro , Brazil
| | - Beatriz de Camargo
- b Pediatric Hematology and Oncology Program, Research Center, Instituto Nacional de Câncer , Rio de Janeiro , Brazil
| | - Julio Fernando Pinto Oliveira
- a Divisão de Vigilância e Análise de Situação Coordenação de Prevenção e Vigilância, Instituto Nacional do Câncer , Rio de Janeiro , Brazil
| | | | - Maria S Pombo-de-Oliveira
- b Pediatric Hematology and Oncology Program, Research Center, Instituto Nacional de Câncer , Rio de Janeiro , Brazil
| |
Collapse
|
10
|
Moura SV, Andrade F, Magalhães IQ, Costa I, Silva DB, D'Andrea ML, Pinheiro VP, Lee MLM, Werneck F, Emerenciano M, Pombo-de-Oliveira MS. Clinical and molecular epidemiology of neonatal leukemia in Brazil. Leuk Lymphoma 2015; 56:903-9. [PMID: 24991719 DOI: 10.3109/10428194.2014.938327] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The clinical and molecular findings of 77 cases of neonatal leukemia (NL) and 380 of infant leukemia (IL) were selected to distinguish features between NL and IL. Somatic gene mutations associated with acute leukemia including FLT3, RAS and PTPN11 were revisited. There were 42 cases of congenital leukemia associated with Down syndrome (DS) and 39 of these cases presented features of acute myeloid leukemia (AML)-M7. Twenty-seven of the DS cases underwent spontaneous remission and were reclassified as a transient myeloproliferative disorder. GATA1 mutations were found in 70% of these cases. In non-DS, frequent abnormalities were MLL rearrangements, mainly MLL-AFF1 in acute lymphoblastic leukemia and MLL-MLLT3 in AML. The FLT3 mutation was not found, while RAS (n = 4) and PTPN11 (n = 2) mutations were identified and reported for the first time in NL. There was substantial evidence to support that somatic abnormalities occur in utero. Thus, congenital leukemia is a good model for understanding leukemogenesis.
Collapse
Affiliation(s)
- Suellen Valadares Moura
- Pediatric Hematology-Oncology Program, Research Center, Instituto Nacional de Câncer , Rio de Janeiro , Brazil
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
The concurrent occurrence of Leishmania chagasi infection and childhood acute leukemia in Brazil. Rev Bras Hematol Hemoter 2014; 36:356-62. [PMID: 25305169 PMCID: PMC4318380 DOI: 10.1016/j.bjhh.2014.07.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 06/04/2014] [Indexed: 11/22/2022] Open
Abstract
Objective This study investigated the co-existence of Leishmania chagasi infection and childhood leukemia in patients naïve to treatment; this has serious clinical and epidemiological implications. Methods The seroprevalence of L. chagasi antibodies prior to any treatment was investigated in children with clinical features of acute leukemia. Serological tests were performed in 470 samples drawn from under 14-year-old children from different regions of Brazil with clinical suspicion of acute leukemia. Acute leukemia subtypes were characterized by immunophenotyping using flow cytometry. Morphological analyses of bone marrow aspirates were systematically performed to visualize blast cells and/or the formation of L. chagasi amastigotes. Data analysis used a standard univariate procedure and the Pearson's chi-square test. Results The plasma of 437 children (93%) displayed antibodies against L. chagasi by indirect immunofluorescence assay and enzyme-linked immunosorbent assay tests. Of the 437 patients diagnosed from 2002 to 2006, 254 had acute lymphoblastic leukemia, 92 had acute myeloid leukemia, and 91 did not have acute leukemia. The seroprevalence of L. chagasi antibodies according to the indirect immunofluorescence assay test (22.5%) was similar in children with or without acute leukemia (p-value = 0.76). The co-existence of visceral leishmanasis and acute leukemia was confirmed in 24 children. The overall survival of these children was poor with a high death rate during the first year of leukemia treatment. Conclusion In the differential diagnosis of childhood leukemia, visceral leishmanasis should be considered as a potential concurrent disease in regions where L. chagasi is endemic.
Collapse
|
12
|
Andrade FG, Furtado-Silva JM, Gonçalves BADA, Thuler LCS, Barbosa TC, Emerenciano M, Siqueira A, Pombo-de-Oliveira MS. RAS mutations in early age leukaemia modulated by NQO1 rs1800566 (C609T) are associated with second-hand smoking exposures. BMC Cancer 2014; 14:133. [PMID: 24571676 PMCID: PMC3946262 DOI: 10.1186/1471-2407-14-133] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 02/17/2014] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Deregulation of the MAPK genes signalling caused by somatic mutations have been implied in leukaemia pathogenesis, including RAS mutation (RASmut) in acute myeloid leukaemia (AML), which has been associated with intra-uterine chemical exposures. A case-case study was conducted in order to explore maternal and child exposures to tobacco smoking associations with early age leukaemia (EAL). METHODS Covariables of reference were MLL rearrangements (MLL-r), RASmut and NQO1 rs1800566 (C609T). Samples from 150 acute lymphoblastic leukaemia (ALL) and 85 AML were included. Maternal exposures were assessed using a structured questionnaire with demographic, personal habits and residence history information. Restriction fragment length polymorphism and denaturing high performance liquid chromatography were used to screen FLT3, KRAS, and NRAS mutations; direct sequencing was performed to validate the results. NQO1 polymorphism was detected by real-time allelic discrimination technique. RESULTS Overall, RASmut were detected in 28.7% of EAL cases; BRAFmut was found only in one AML patient. Higher rate of KRASmut was found in ALL (30.3%) compared to AML (20.8%) with MLL-r; RASmut showed an association with second-hand tobacco smoking exposures (OR, 3.06, 95% CI, 1.03-9.07). A considerable increased risk for EAL with the combination of RASmut and NQO1 609CT (OR, 4.24, 95% CI, 1.24-14.50) was observed. CONCLUSIONS Our data demonstrated the increased risk association between maternal smoking and EAL with MLL-r. Additionally, suggests that children second-hand tobacco exposures are associated with increased risk of EAL with RASmut modulated by NQO1 rs1800566 (C609T).
Collapse
Affiliation(s)
- Francianne Gomes Andrade
- Paediatric Haematology-Oncology Program, Research Centre, Instituto Nacional de Câncer - INCA, Rua André Cavalcanti, 37, Rio de Janeiro/RJ 20231-050, Brasil
| | - Juliana Montibeller Furtado-Silva
- Paediatric Haematology-Oncology Program, Research Centre, Instituto Nacional de Câncer - INCA, Rua André Cavalcanti, 37, Rio de Janeiro/RJ 20231-050, Brasil
- Great Ormond Street Hospital, London, United Kingdom
| | - Bruno Alves de Aguiar Gonçalves
- Paediatric Haematology-Oncology Program, Research Centre, Instituto Nacional de Câncer - INCA, Rua André Cavalcanti, 37, Rio de Janeiro/RJ 20231-050, Brasil
| | | | - Thayana Conceição Barbosa
- Paediatric Haematology-Oncology Program, Research Centre, Instituto Nacional de Câncer - INCA, Rua André Cavalcanti, 37, Rio de Janeiro/RJ 20231-050, Brasil
| | - Mariana Emerenciano
- Paediatric Haematology-Oncology Program, Research Centre, Instituto Nacional de Câncer - INCA, Rua André Cavalcanti, 37, Rio de Janeiro/RJ 20231-050, Brasil
| | | | - Maria S Pombo-de-Oliveira
- Paediatric Haematology-Oncology Program, Research Centre, Instituto Nacional de Câncer - INCA, Rua André Cavalcanti, 37, Rio de Janeiro/RJ 20231-050, Brasil
| |
Collapse
|
13
|
Barbosa TC, Andrade FG, Lopes BA, de Andrade CFG, Mansur MB, Emerenciano M, Pombo-de-Oliveira MS. Impact of mutations in FLT3, PTPN11 and RAS genes on the overall survival of pediatric B cell precursor acute lymphoblastic leukemia in Brazil. Leuk Lymphoma 2014; 55:1501-9. [PMID: 24067137 DOI: 10.3109/10428194.2013.847934] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We analyzed mutations in four genes (FLT3, KRAS/NRAS and PTPN11) that might disrupt the RAS/mitogen activated protein kinase (MAPKinase) signaling pathway, to evaluate their prognostic value in children younger than 16 years old with B-cell precursor acute lymphoblastic leukemia (Bcp-ALL). The overall survival (OS) was determined with the Kaplan-Meier method. MAPKinase genes were mutated in 25.4% and 20.1% of childhood and infant Bcp-ALL, respectively. Children with hyperdiploidy were more prone to harboring a MAPKinase gene mutation (odds ratio [OR] 3.18; 95% confidence interval [CI] 1.07-9.49). The mean OS of all cases was 54.0 months. FLT3 and PTPN11 mutations had no impact on OS. K/NRAS mutations were strongly associated with MLL-AFF1 (OR 5.78; 95% CI 1.00-33.24), and conferred poorer OS (p = 0.034) in univariate analysis.
Collapse
Affiliation(s)
- Thayana Conceição Barbosa
- Pediatric Hematology and Oncology Program, Research Center, Instituto Nacional de Câncer , Rio de Janeiro , Brazil
| | | | | | | | | | | | | |
Collapse
|
14
|
Pregnancy, maternal exposure to hair dyes and hair straightening cosmetics, and early age leukemia. Chem Biol Interact 2013; 205:46-52. [DOI: 10.1016/j.cbi.2013.05.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 05/16/2013] [Accepted: 05/23/2013] [Indexed: 02/06/2023]
|
15
|
Familial history of cancer and leukemia in children younger than 2 years of age in Brazil. Eur J Cancer Prev 2013; 22:151-7. [DOI: 10.1097/cej.0b013e3283581d1f] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
16
|
Emerenciano M, Meyer C, Mansur MB, Marschalek R, Pombo-de-Oliveira MS. The distribution ofMLLbreakpoints correlates with outcome in infant acute leukaemia. Br J Haematol 2013; 161:224-36. [DOI: 10.1111/bjh.12250] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 01/03/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Mariana Emerenciano
- Paediatric Haematology-Oncology Program; Research Centre, Instituto Nacional de Câncer; Rio de Janeiro; Brazil
| | - Claus Meyer
- Institute of Pharmaceutical Biology/ZAFES/Diagnostic Centre of Acute Leukaemia (DCAL); Goethe-University of Frankfurt; Frankfurt/Main; Germany
| | - Marcela B. Mansur
- Paediatric Haematology-Oncology Program; Research Centre, Instituto Nacional de Câncer; Rio de Janeiro; Brazil
| | - Rolf Marschalek
- Institute of Pharmaceutical Biology/ZAFES/Diagnostic Centre of Acute Leukaemia (DCAL); Goethe-University of Frankfurt; Frankfurt/Main; Germany
| | - Maria S. Pombo-de-Oliveira
- Paediatric Haematology-Oncology Program; Research Centre, Instituto Nacional de Câncer; Rio de Janeiro; Brazil
| | | |
Collapse
|
17
|
Ferman S, Santos MDO, Ferreira JMDO, Reis RDS, Oliveira JFP, Pombo-de-Oliveira MS, Camargo BD. Childhood cancer mortality trends in Brazil, 1979-2008. Clinics (Sao Paulo) 2013; 68:219-24. [PMID: 23525319 PMCID: PMC3584264 DOI: 10.6061/clinics/2013(02)oa16] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 10/26/2012] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Childhood cancer mortality has substantially declined worldwide as a result of significant advances in global cancer care. Because limited information is available in Brazil, we analyzed trends in childhood cancer mortality in five Brazilian regions over 29 years. METHODS Data from children 0-14 years old were extracted from the Health Mortality Information System for 1979 through 2008. Age-adjusted mortality rates, crude mortality rates, and age-specific mortality rates by geographic region of Brazil and for the entire country were analyzed for all cancers and leukemia. Mortality trends were evaluated for all childhood cancers and leukemia using joinpoint regression. RESULTS Mortality declined significantly for the entire period (1979-2008) for children with leukemia. Childhood cancer mortality rates declined in the South and Southeast, remained stable in the Middle West, and increased in the North and Northeast. Although the mortality rates did not unilaterally decrease in all regions, the age-adjusted mortality rates were relatively similar among the five Brazilian regions from 2006-2008. CONCLUSIONS Childhood cancer mortality declined 1.2 to 1.6% per year in the South and Southeast regions.
Collapse
Affiliation(s)
- Sima Ferman
- Pediatric Oncology Department, Instituto Nacional de Câncer, Rio de Janeiro, RJ, Brazil
| | | | | | | | | | | | | |
Collapse
|
18
|
NQO1 rs1800566 (C609T), PON1 rs662 (Q192R), and PON1 rs854560 (L55M) polymorphisms segregate the risk of childhood acute leukemias according to age range distribution. Cancer Causes Control 2012; 23:1811-9. [DOI: 10.1007/s10552-012-0060-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 08/28/2012] [Indexed: 12/17/2022]
|
19
|
Mansur MB, Hassan R, Barbosa TC, Splendore A, Jotta PY, Yunes JA, Wiemels JL, Pombo-de-Oliveira MS. Impact of complex NOTCH1 mutations on survival in paediatric T-cell leukaemia. BMC Cancer 2012; 12:9. [PMID: 22225590 PMCID: PMC3305583 DOI: 10.1186/1471-2407-12-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Accepted: 01/06/2012] [Indexed: 11/10/2022] Open
Abstract
Background Molecular alterations occur frequently in T-ALL and the potential impact of those abnormalities on outcome is still controversial. The current study aimed to test whether NOTCH1 mutations and additional molecular abnormalities would impact T-ALL outcome in a series of 138 T-ALL paediatric cases. Methods T-ALL subtypes, status of SIL-TAL1 fusion, ectopic expression of TLX3, and mutations in FBXW7, KRAS, PTEN and NOTCH1 were assessed as overall survival (OS) and event-free survival (EFS) prognostic factors. OS and EFS were determined using the Kaplan-Meier method and compared using the log-rank test. Results The frequencies of mutations were 43.5% for NOTCH1, while FBXW7, KRAS and PTEN exhibited frequencies of 19.1%, 9.5% and 9.4%, respectively. In 78.3% of cases, the coexistence of NOTCH1 mutations and other molecular alterations was observed. In multivariate analysis no statistical association was revealed between NOTCH1 mutations and any other variable analyzed. The mean length of the follow-up was 68.4 months and the OS was 50.7%. SIL-TAL1 was identified as an adverse prognostic factor. NOTCH1 mutation status was not associated with outcome, while the presence of NOTCH1 complex mutations (indels) were associated with a longer overall survival (p = 0.031) than point mutations. Conclusion NOTCH1 mutations alone or in combination with FBXW7 did not impact T-ALL prognosis. Nevertheless, complex NOTCH1 mutations appear to have a positive impact on OS and the SIL-TAL1 fusion was validated as a negative prognostic marker in our series of T-ALL.
Collapse
Affiliation(s)
- Marcela Braga Mansur
- Paediatric Haematology-Oncology Program, Research Centre, Instituto Nacional de Câncer, Rio de Janeiro, RJ, Brazil
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Noronha EP, Marinho HT, Thomaz EBAF, Silva CA, Veras GLR, Oliveira RAG. Immunophenotypic characterization of acute leukemia at a public oncology reference center in Maranhão, northeastern Brazil. SAO PAULO MED J 2011; 129:392-401. [PMID: 22249795 PMCID: PMC10868919 DOI: 10.1590/s1516-31802011000600005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Revised: 04/19/2011] [Accepted: 05/03/2011] [Indexed: 11/21/2022] Open
Abstract
CONTEXT AND OBJECTIVES The incidence of acute leukemia (AL) subtypes varies according to geographical distribution. The aim here was to determine the incidence of morphological and immunophenotypic AL subtypes in the state of Maranhão, Brazil, and to correlate the expression of aberrant phenotypes in children with acute lymphoblastic leukemia (ALL) with prognostic factors. DESIGN AND SETTING Single prospective cohort study at a public oncology reference center in Maranhão. METHODS Seventy AL cases were diagnosed between September 2008 and January 2010. For the diagnosis, complete blood cell counts, myelograms (at diagnosis and at the end of the induction phase), cytochemical analysis and immunophenotyping were performed. RESULTS Among adult patients (n = 22), the incidence of AL types was: ALL (22.7%) and acute myeloid leukemia (AML) (77.3%). The subtype AML M0 occurred most frequently (29.4%). In children (n = 48), the types were: AML (18.7%), most frequently subtype AML M4 (33.4%); biphenotypic acute leukemia (BAL) (4.2%); and ALL (77.1%), including the subtypes B-ALL (72.9%) and T-ALL (27.1%). Among the children with ALL, there were no statistically significant differences between patients with and without aberrant phenotypes, in relation to hematological parameters and treatment response. CONCLUSION This work demonstrates that the frequencies of AML M0 cases among adults and T-ALL cases among children in Maranhão were high. This suggests that there may be differences in AML subtype incidence, as seen with ALL subtypes, in different regions of Brazil. No association was found between the expression of aberrant phenotypes and prognostic factors, in children with ALL.
Collapse
Affiliation(s)
- Elda Pereira Noronha
- Clinical Research Center, University Hospital, Universidade Federal do Maranhão, São Luís, Maranhão, Brazil.
| | | | | | | | | | | |
Collapse
|
21
|
Emerenciano M, Renaud G, Sant'Ana M, Barbieri C, Passetti F, Pombo-de-Oliveira MS. Challenges in the use of NG2 antigen as a marker to predict MLL rearrangements in multi-center studies. Leuk Res 2011; 35:1001-7. [PMID: 21444110 DOI: 10.1016/j.leukres.2011.03.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 03/03/2011] [Accepted: 03/04/2011] [Indexed: 10/18/2022]
Abstract
Rearrangements in MLL (MLL-r) are common within very young children with leukemia and affect the prognosis and treatment. Previous studies have suggested the use of the NG2 molecule as a marker for MLL-r but these studies were performed using a small number of infants. We analyzed 148 patients (all less than 24 months, 86 less than 12 months) from various centers in Brazil to determine the predictive power of NG2 within that cohort. We show that NG2 can be used for MLL-r prediction; however, proper staff training and standardized sampling procedures are essential when receiving samples from multiple centers as the accuracy of the prediction varies greatly on a per center basis.
Collapse
Affiliation(s)
- Mariana Emerenciano
- Pediatric Hematology and Oncology Program, Research Center, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | | | | | | | | | | | | |
Collapse
|
22
|
de Souza Reis R, de Camargo B, de Oliveira Santos M, de Oliveira JM, Azevedo Silva F, Pombo-de-Oliveira MS. Childhood leukemia incidence in Brazil according to different geographical regions. Pediatr Blood Cancer 2011; 56:58-64. [PMID: 21108440 DOI: 10.1002/pbc.22736] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Resource-rich countries tend to have a higher incidence of childhood acute lymphoblastic leukemia (ALL), whereas lower rates are seen in more deprived countries. This study describes the incidence of childhood acute leukemia in Brazil, an upper middle-income country, based on data from 16 population-based cancer registries (PBCRs). PROCEDURE Data were examined from 16 PBCRs in Brazilian cities located in five geographical regions during the period from 1997 to 2004. Incidence rates were analyzed according to gender, age, and type of leukemia. The Wilcoxon test was performed to evaluate for gender-age based difference between by leukemia type. RESULTS The median age-adjusted incidence rate (AAIR) of leukemia in children aged 0-14 years old was 53.3 per million. A different AAIR was found regarding ALL and myeloproliferative disorders (MPD) that ranged from 24.8 to 76.84 per 1,000,000 children. Manaus, although located in a poor area of Brazil, exhibited the highest AAIR (56.6 per million) of ALL. Goiania had the highest AAIR (24.5 per million) of MPD. The median age-specific incidence rate (ASIR) for the 16 Brazilian PBCRs demonstrated a marked peak in incidence of ALL at age 3 years old, in both genders. CONCLUSIONS This population-based study of childhood leukemia demonstrates that substantial regional differences exist regarding the incidence of acute leukemia in Brazil, which warrants further ecological study.
Collapse
Affiliation(s)
- Rejane de Souza Reis
- Coordenação de Prevenção e Vigilância, Instituto Nacional do Câncer, Rua dos Inválidos, Rio de Janeiro, Brazil
| | | | | | | | | | | |
Collapse
|
23
|
Azevedo-Silva F, Camargo BD, Pombo-de-Oliveira MS. Implications of infectious diseases and the adrenal hypothesis for the etiology of childhood acute lymphoblastic leukemia. Braz J Med Biol Res 2010; 43:226-9. [PMID: 20401428 DOI: 10.1590/s0100-879x2010007500011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Accepted: 02/01/2010] [Indexed: 02/02/2023] Open
Abstract
Acute leukemia is the most frequent cancer in children. Recently, a new hypothesis was proposed for the pathogenesis of childhood acute lymphoblastic leukemia (ALL). The so-called 'adrenal hypothesis' emphasized the role of endogenous cortisol in the etiology of B-cell precursor ALL. The incidence peak of ALL in children between 3 to 5 years of age has been well documented and is consistent with this view. The adrenal hypothesis proposes that the risk of childhood B-cell precursor ALL is reduced when early childhood infections induce qualitative and quantitative changes in the hypothalamus-pituitary-adrenal axis. It suggests that the increased plasma cortisol levels would be sufficient to eliminate all clonal leukemic cells originating during fetal life. Because Brazil is a continental and tropical country, the exposure to infections is diversified with endemic viral and regionally non-viral infections, with some characteristics that support the recent adrenal hypothesis. Here we discuss this new hypothesis in terms of data from epidemiological studies and the possible implications of the diversity of infections occurring in Brazilian children.
Collapse
Affiliation(s)
- F Azevedo-Silva
- Centro de Pesquisa, Instituto Nacional de Câncer, Rio de Janeiro, RJ, Brasil
| | | | | |
Collapse
|
24
|
de Camargo B, de Oliveira Santos M, Rebelo MS, de Souza Reis R, Ferman S, Noronha CP, Pombo-de-Oliveira MS. Cancer incidence among children and adolescents in Brazil: first report of 14 population-based cancer registries. Int J Cancer 2010; 126:715-20. [PMID: 19642142 DOI: 10.1002/ijc.24799] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Brazilian Population-Based Cancer Registry (PBCR) was started in 1967; today there are 20 PBCRs in Brazil. We report the first descriptive analysis of the incidence of childhood cancer based on data from 14 PBCRs, corresponding to 15% of the child and adolescent population in Brazil. Data were obtained from registry databases, including information on population coverage and data quality indicators. The International Classification of Childhood Cancer was used. Age-adjusted rates were calculated by world population. Incidence by cancer registry, age, sex, and cancer type were calculated per 1,000,000 children. Age-adjusted rates per 1,000,000 children/adolescents ranged from 92 to 220 among the 14 PBCRs. The principal groups of cancers were leukemia, lymphoma and central nervous tumors. The median incidence rate of childhood cancer in the 14 PBCRs was 154.3 per million; children 1-4 years of age had the highest incidence rates. The Brazilian PBCRs provide important information about pediatric cancer incidence in an emerging country. The observed incidence rates of childhood leukemia were similar to previous reported rates, and the age-specific incidence rates of retinoblastoma (0-4 years of age) were higher than those for developed countries. These data can be used as baseline incidence rates of childhood and adolescent cancer in Brazil in future epidemiological studies.
Collapse
Affiliation(s)
- Beatriz de Camargo
- Pediatric Hematology and Oncology Program, Research Center, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | | | | | | | | | | | | |
Collapse
|
25
|
Azevedo-Silva F, Reis RDS, de Oliveira Santos M, Luiz RR, Pombo-de-Oliveira MS. Evaluation of childhood acute leukemia incidence and underreporting in Brazil by capture–recapture methodology. Cancer Epidemiol 2009; 33:403-5. [DOI: 10.1016/j.canep.2009.09.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Revised: 09/08/2009] [Accepted: 09/16/2009] [Indexed: 10/20/2022]
|
26
|
|