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Soliman R, Bolous N, Heneghan C, Oke J, Boylan AM, Eweida W, Abouelnaga S, Elhaddad A. An overview of childhood cancer care and outcomes in Egypt: a narrative review. Ecancermedicalscience 2024; 18:1676. [PMID: 38439811 PMCID: PMC10911675 DOI: 10.3332/ecancer.2024.1676] [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: 12/03/2023] [Indexed: 03/06/2024] Open
Abstract
Childhood cancer is an urgent priority in Egypt, owing to a large number of children with cancer, the great need and demand for paediatric oncology services, limited resources/funds and inferior survival outcomes. Therefore, an overview of the status of childhood cancer care in Egypt and an evidence-based approach towards optimal utilisation of resources/funds to improve this care are needed. This paper summarises key evidence about childhood cancer care and outcomes in Egypt. We conducted a narrative literature review using a structured search strategy of the MEDLINE database through the PubMed interface. All relevant evidence was summarised under five main sub-topics: (1) burden of childhood cancer in Egypt; (2) treatment approaches; (3) health outcomes; (4) costs and cost-effectiveness of treatment; and (5) barriers and facilitators to optimal childhood cancer care. We found high estimates of disease burden of childhood cancer in Egypt. Furthermore, childhood cancer treatment in Egypt is based on either implementing intensity-regulated protocols or adopting international protocols with or without adaptations to local contexts, leading to varying standards of care among the different treating centres. Limited data about the survival outcomes, costs and cost-effectiveness of treatment exist, although high-quality data from retrospective cohort studies were published from a large paediatric oncology centre (Children's Cancer Hospital Egypt-57357). As Egypt joins the WHO Global Initiative for Childhood Cancers as a focus country, it is prepared to move towards streamlining national efforts to implement a national childhood cancer plan to advance care, improve health outcomes and optimise resource use. Through these efforts, Egypt could become a beacon of hope and a role model to other low- and middle-income countries seeking to improve their childhood cancer care.
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Affiliation(s)
- Ranin Soliman
- Health Economics and Value Unit, Children’s Cancer Hospital 57357 Egypt (CCHE), Cairo 4260102, Egypt
- Centre for Evidence-Based Medicine, University of Oxford, OX1 2JD Oxford, UK
- Co-first authors
| | - Nancy Bolous
- Department of Global Pediatric Medicine, St Jude Children’s Research Hospital, Memphis, TN 38105, USA
- Co-first authors
| | - Carl Heneghan
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX1 2JD Oxford, UK
| | - Jason Oke
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX1 2JD Oxford, UK
| | - Anne-Marie Boylan
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX1 2JD Oxford, UK
| | - Wael Eweida
- Chief Operating Office, Children’s Cancer Hospital 57357 Egypt (CCHE), Cairo 4260102, Egypt
| | - Sherif Abouelnaga
- Chief Executive Office, Children’s Cancer Hospital 57357 Egypt (CCHE), Cairo 4260102, Egypt
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo 11796, Egypt
| | - Alaa Elhaddad
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo 11796, Egypt
- Paediatric Oncology Department, Children’s Cancer Hospital 57357 Egypt (CCHE), Cairo 4260102, Egypt
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Ramadhan MH, Sari NM, Peryoga SU, Susanah S. Survival and Treatment Outcomes of Childhood Acute Lymphoblastic Leukemia in a Low-Middle Income Country: A Single-Center Experience in West Java, Indonesia. J Blood Med 2024; 15:77-85. [PMID: 38405084 PMCID: PMC10887884 DOI: 10.2147/jbm.s438042] [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: 08/31/2023] [Accepted: 01/18/2024] [Indexed: 02/27/2024] Open
Abstract
Purpose This study aimed to determine the survival rates and treatment outcomes of patients with childhood Acute Lymphoblastic Leukemia (ALL) in a single-center study at Indonesia. Patients and Methods Factors contributing to the relapse and survival of ALL in Bandung, Indonesia, were evaluated. Data were collected from the medical record and the Indonesian Pediatric Cancer Registry (IPCAR). Subsequently, univariate and multivariate analyses were evaluated using Cox proportional hazard regression and Kaplan Meier was used for survival analysis. An analytic observational study was conducted on newly diagnosed children aged 1-18 with ALL from January 2019 to December 2022. Results A total of 137 children were included in the analysis, 30 (21,9%) were dropped out during treatment and 60.5% died during the study period. Most of the deaths occurred after relapse in 32 (38.5%) with a high early relapse (70.5%), occurring mainly during the maintenance phase (42.4%). At the one-year mark, the observed overall survival (OS) rate was at 36%, while event-free survival (EFS) was lower, at 19%. Univariate Cox regression analysis showed that the leucocyte counts at diagnosis (p=0.005) and response to induction phase (p < 0.008) was associated with the death of ALL. Furthermore, a response to induction phase was significant [hazard ratio 4.67 (CI 95%: 1.64-13.29); p = 0.004] in the multivariate analysis. Conclusion In conclusion, this study underscored the persistent challenges of high treatment discontinuation rates and the occurrence of very early relapses in low- to middle-income countries (LMICs), which significantly impacted the OS of children diagnosed with ALL.
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Affiliation(s)
- Monika Hasna Ramadhan
- Department of Child Health, Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Nur Melani Sari
- Department of Child Health, Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Stanza Uga Peryoga
- Department of Child Health, Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Susi Susanah
- Department of Child Health, Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin Hospital, Bandung, Indonesia
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van Weelderen RE, Wijnen NE, Njuguna F, Klein K, Vik TA, Olbara G, Kaspers GJL. Treatment outcomes of pediatric acute myeloid leukemia in Western Kenya before and after the implementation of the SIOP PODC treatment guideline. Cancer Rep (Hoboken) 2023; 6:e1849. [PMID: 37349659 PMCID: PMC10432428 DOI: 10.1002/cnr2.1849] [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: 04/19/2023] [Revised: 05/24/2023] [Accepted: 06/12/2023] [Indexed: 06/24/2023] Open
Abstract
PURPOSE The Pediatric Oncology in Developing Countries (PODC) committee of the International Society of Pediatric Oncology (SIOP) published a pediatric acute myeloid leukemia (AML)-specific adapted treatment guideline for low- and middle-income countries. We evaluated the outcomes of children with AML at a large Kenyan academic hospital before (period 1) and after (period 2) implementing this guideline. PATIENTS AND METHODS Records of children (≤17 years) newly diagnosed with AML between 2010 and 2021 were retrospectively studied. In period 1, induction therapy comprised two courses with doxorubicin and cytarabine, and consolidation comprised two courses with etoposide and cytarabine. In period 2, a prephase with intravenous low-dose etoposide was administered prior to induction therapy, induction course I was intensified, and consolidation was adapted to two high-dose cytarabine courses. Probabilities of event-free survival (pEFS) and overall survival (pOS) were estimated using the Kaplan-Meier method. RESULTS One-hundred twenty-two children with AML were included - 83 in period 1 and 39 in period 2. Overall, 95 patients received chemotherapy. The abandonment rate was 19% (16/83) in period 1 and 3% (1/39) in period 2. The early death, treatment-related mortality, complete remission, and relapse rates in periods 1 and 2 were 46% (29/63) versus 44% (14/32), 36% (12/33) versus 47% (8/17), 33% (21/63) versus 38% (12/32), and 57% (12/21) versus 17% (2/12), respectively. The 2-year pEFS and pOS in periods 1 and 2 were 5% versus 15% (p = .53), and 8% versus 16% (p = .93), respectively. CONCLUSION The implementation of the SIOP PODC guideline did not result in improved outcomes of Kenyan children with AML. Survival of these children remains dismal, mainly attributable to early mortality.
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Affiliation(s)
- Romy E. van Weelderen
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
- Pediatric OncologyPrincess Máxima Center for Pediatric OncologyUtrechtThe Netherlands
| | - Noa E. Wijnen
- Pediatric OncologyPrincess Máxima Center for Pediatric OncologyUtrechtThe Netherlands
| | - Festus Njuguna
- Child Health and PediatricsMoi University/Moi Teaching and Referral HospitalEldoretKenya
| | - Kim Klein
- Pediatric OncologyPrincess Máxima Center for Pediatric OncologyUtrechtThe Netherlands
- Wilhelmina Children's HospitalUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Terry A. Vik
- PediatricsIndiana University School of MedicineIndianapolisIndianaUSA
| | - Gilbert Olbara
- Child Health and PediatricsMoi University/Moi Teaching and Referral HospitalEldoretKenya
| | - Gertjan J. L. Kaspers
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
- Pediatric OncologyPrincess Máxima Center for Pediatric OncologyUtrechtThe Netherlands
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4
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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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5
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Malvezzi M, Santucci C, Alicandro G, Carioli G, Boffetta P, Ribeiro KB, Levi F, La Vecchia C, Negri E, Bertuccio P. Childhood cancer mortality trends in the Americas and Australasia: An update to 2017. Cancer 2021; 127:3445-3456. [PMID: 34043810 PMCID: PMC8453533 DOI: 10.1002/cncr.33642] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/19/2021] [Accepted: 04/26/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Marked reductions in childhood cancer mortality occurred over the last decades in high-income countries and, to a lesser degree, in middle-income countries. This study aimed to monitor mortality trends in the Americas and Australasia, focusing on areas showing unsatisfactory trends. METHODS Age-standardized mortality rates per 100,000 children (aged 0-14 years) from 1990 to 2017 (or the last available calendar year) were computed for all neoplasms and 8 leading childhood cancers in countries from the Americas and Australasia, using data from the World Health Organization database. A joinpoint regression was used to identify changes in slope of mortality trends for all neoplasms, leukemia, and neoplasms of the central nervous system (CNS) for major countries. RESULTS Over the last decades, childhood cancer mortality continued to decrease by approximately 2% to 3% per year in Australasian countries (ie, Japan, Korea, and Australia), by approximately 1.5% to 2% in North America and Chile, and 1% in Argentina. Other Latin American countries did not show any substantial decrease. Leukemia mortality declined in most countries, whereas less favorable trends were registered for CNS neoplasms, particularly in Latin America. Around 2016, death rates from all neoplasms were 4 to 6 per 100,000 boys and 3 to 4 per 100,000 girls in Latin America, and 2 to 3 per 100,000 boys and approximately 2 per 100,000 girls in North America and Australasia. CONCLUSIONS Childhood cancer mortality trends declined steadily in North America and Australasia, whereas they were less favorable in most Latin American countries. Priority must be given to closing the gap by providing high-quality care for all children with cancer worldwide. LAY SUMMARY Advances in childhood cancer management have substantially improved the burden of these neoplasms over the past 40 years, particularly in high-income countries. This study aimed to monitor recent trends in America and Australasia using mortality data from the World Health Organization. Trends in childhood cancer mortality continued to decline in high-income countries by approximately 2% to 3% per year in Japan, Korea, and Australia, and 1% to 2% in North America. Only a few Latin American countries showed favorable trends, including Argentina, Chile, and Mexico, whereas other countries with limited resources still lagged behind.
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Affiliation(s)
- Matteo Malvezzi
- Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanItaly
| | - Claudia Santucci
- Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanItaly
| | - Gianfranco Alicandro
- Department of Pathophysiology and TransplantationUniversità degli Studi di MilanoMilanItaly
| | - Greta Carioli
- Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanItaly
| | - Paolo Boffetta
- Stony Brook Cancer CenterStony Brook UniversityStony BrookNew York
- Department of Medical and Surgical SciencesUniversity of BolognaBolognaItaly
| | - Karina Braga Ribeiro
- Department of Collective HealthFaculdade de Ciências Médicas da Santa Casa de São PauloSão PauloBrazil
- Department of Pediatric OncologyHospital Santa Marcelina/TUCCASão PauloBrazil
| | - Fabio Levi
- Department of Epidemiology and Health Services ResearchCentre for Primary Care and Public Health (Unisanté)University of LausanneLausanneSwitzerland
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanItaly
| | - Eva Negri
- Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanItaly
| | - Paola Bertuccio
- Department of Biomedical and Clinical Sciences L. SaccoUniversità degli Studi di MilanoMilanItaly
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6
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Muñoz-Aguirre P, Huerta-Gutierrez R, Zamora S, Mohar A, Vega-Vega L, Hernández-Ávila JE, Morales-Carmona E, Zapata-Tarres M, Bautista-Arredondo S, Perez-Cuevas R, Rivera-Luna R, Reich MR, Lajous M. Acute Lymphoblastic Leukaemia Survival in Children Covered by Seguro Popular in Mexico: A National Comprehensive Analysis 2005-2017. Health Syst Reform 2021; 7:e1914897. [PMID: 34125000 DOI: 10.1080/23288604.2021.1914897] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
The aim of the study was to measure survival of children with acute lymphoblastic leukemia (ALL) under Mexico's public health insurance for the population treated under Seguro Popular. A retrospective cohort study using claims data from Mexico's Seguro Popular program, covering cancer treatment from 2005 to 2015 was conducted. Overall 5-year national and state-specific survival for children with ALL across Mexico who initiated cancer treatment under this program was estimated. From 2005 to 2015, 8,977 children with ALL initiated treatment under Seguro Popular. Under this financing scheme, the annual number of treated children doubled from 535 in 2005 to 1,070 in 2015. The estimates for 5-year overall survival of 61.8% (95%CI 60.8, 62.9) remained constant over time. We observed wide gaps in risk-standardized 5-year overall survival among states ranging from 74.7% to 43.7%. We found a higher risk of mortality for children who received treatment in a non-pediatric specialty hospital (Hazards Ratio, HR = 1.18; 95%CI 1.09, 1.26), facilities without a pediatric oncology/hematology specialist (HR = 2.17; 95%CI 1.62, 2.90), and hospitals with low patient volume (HR = 1.22; 95%CI 1.13, 1.32). In a decade Mexico's Seguro Popular doubled access to ALL treatment for covered children and by 2015 financed the vast majority of estimated ALL cases for that population. While some progress in ALL survival may have been achieved, nationwide 5-year overall survival did not improve over time and did not achieve levels found in comparable countries. Our results provide lessons for Mexico's evolving health system and for countries moving toward universal health coverage.
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Affiliation(s)
| | - Rodrigo Huerta-Gutierrez
- Centre for Research on Population Health, INSP (Instituto Nacional de Salud Pública), Cuernavaca, Mexico
| | - Salvador Zamora
- Instituto de Investigaciones en Matemáticas Aplicadas y en Sistemas, UNAM (Universidad Nacional Autónoma de México), Mexico City, Mexico
| | - Alejandro Mohar
- Epidemiology Unit, INCan (Instituto Nacional de Cancerología), Mexico City, Mexico.,Departement of Genetics and Environmenatl Toxicology, Instituto de Investigaciones Biomédicas-UNAM, Mexico City, Mexico
| | - Lourdes Vega-Vega
- Dirección General, Hospital Infantil Teletón de Oncología, Querétaro, Mexico
| | | | | | - Marta Zapata-Tarres
- Division of Paediatric Haematology/Oncology, National Institute of Paediatrics, Mexico City, México
| | - Sergio Bautista-Arredondo
- Centre for Research on Health Systems, INSP (Instituto Nacional de Salud Pública), Cuernavaca, Mexico
| | - Ricardo Perez-Cuevas
- Division of Social Protection and Health, Jamaica Country Office, Inter-American Development Bank, Kingston, Jamaica
| | - Roberto Rivera-Luna
- Division of Paediatric Haematology/Oncology, National Institute of Paediatrics, Mexico City, México
| | - Michael R Reich
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Martin Lajous
- Centre for Research on Population Health, INSP (Instituto Nacional de Salud Pública), Cuernavaca, Mexico.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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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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8
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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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9
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Wali R, Anjum S, Amjad A, Shaheen N, Khan SJ. Frequency of Infectious Mortality at the End of Induction Chemotherapy in Acute Lymphoblastic Leukemia and Lymphoma Patients: Findings From a Tertiary Care Cancer Center. Cureus 2021; 13:e13208. [PMID: 33717747 PMCID: PMC7943861 DOI: 10.7759/cureus.13208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background and objective In low- and low-to-middle-income countries (LMICs), the incidence of treatment-related mortality (TRM) in patients with acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL) is up to 52%. This study aimed to determine the mortality rate at the end of the induction phase of the treatment among patients with ALL and lymphoma at a tertiary care cancer center. Methods This retrospective study analyzed outcomes after induction chemotherapy in pediatric patients with acute leukemia and lymphoma at a tertiary care cancer center from January 2015 to December 2016. Information regarding demographics, clinical characteristics, and laboratory investigations were extracted and reviewed. Results Of the total 160 patients, 110 were males, and the mean age of the sample was 4.6 +2.8 years. B-cell leukemia (pre-B-ALL) was diagnosed in 84% (n=134), while 10% (n=6) had acute T-cell leukemia (pre-T-ALL) and 6% (n=10) had lymphoma. Sixteen patients (10%) died within the defined induction period, with 14 deaths occurring due to infections and two deaths resulting from chemotherapy-related toxicity. Conclusion Based on our findings, there is a significant prospect of mortality from infections during induction chemotherapy in patients with pediatric hematological malignancies.
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Affiliation(s)
- Rabia Wali
- Paediatric Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Sadia Anjum
- Paediatric Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | | | - Najma Shaheen
- Paediatric Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Saadiya Javed Khan
- Paediatrics and Child Health, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
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10
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Basbous M, Al-Jadiry M, Belgaumi A, Sultan I, Al-Haddad A, Jeha S, Saab R. Childhood cancer care in the Middle East, North Africa, and West/Central Asia: A snapshot across five countries from the POEM network. Cancer Epidemiol 2020; 71:101727. [PMID: 32499117 DOI: 10.1016/j.canep.2020.101727] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/20/2020] [Accepted: 04/22/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Pediatric Oncology East and Mediterranean (POEM) network, through this report, provides a snapshot view of an expected child's treatment journey in five countries in the region. METHODS Pediatric oncologists from cancer centers in Egypt, Lebanon, Iraq, Jordan, and Pakistan provided input on referral pathways, barriers to care, and patient outcomes, based on personal experience and published data. Outcome data were extracted from institutional registries. A literature review of articles and meeting abstracts was conducted, and results summarized. RESULTS Countries across the Middle Eastern, North African, and West Asian region face common difficulties relating to the provision of pediatric oncology care. National registries are largely lacking, with unavailability of outcome data. Economic barriers are a common theme, leading to delays in patient diagnosis, and interruptions and abandonment of therapy. Insufficient infrastructure and human resources, high rates of toxic deaths, and lack of common national protocols are common. The establishment of successful fundraising organizations linked to specific cancer hospitals showcase several success stories, enhancing services, improving patient access, and leading to outcomes comparable to those in developed countries. All identified published literature is institution-based and from only one or a few hospitals. Therefore, outcomes at a national level likely differ due to disparate cancer care capabilities. CONCLUSION Well-designed national registries are essential for identifying gaps, and clear referral networks are needed to address delays to diagnosis and therapy. National and transversal programs to improve infrastructure, facilitate knowledge transfer, and promote advocacy, are needed to accelerate progress in the region.
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Affiliation(s)
- Maya Basbous
- Children's Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mazin Al-Jadiry
- Department of Pediatrics, College of Medicine-University of Baghdad, Children's Welfare Teaching Hospital-Medical City, Baghdad, Iraq
| | - Asim Belgaumi
- Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Iyad Sultan
- Pediatric Oncology, King Hussein Cancer Centre, Amman, Jordan
| | - Alaa Al-Haddad
- Pediatric Oncology Department and Pediatric Stem Cell Transplantation Unit, Children's Cancer Hospital Egypt (CCHE 57357), Cairo, Egypt; Pediatric Oncology Department and Hematopoietic Stem Cell Transplantation, National Cancer Institute (NCI), Cairo University, Cairo, Egypt
| | - Sima Jeha
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Raya Saab
- Children's Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon; Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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Semary SF, Hammad M, Soliman S, Yassen D, Gamal M, Albeltagy D, Hamdy N, Mahmoud S. Outcome of Childhood Acute Myeloid Leukemia With FLT3-ITD Mutation: The Experience of Children's Cancer Hospital Egypt, 2007-17. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:e529-e541. [PMID: 32473792 DOI: 10.1016/j.clml.2020.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/12/2020] [Accepted: 04/13/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The presence of FMS-like tyrosine kinase 3 (FLT3) internal tandem duplication (ITD) mutation in pediatric acute myeloid leukemia (AML) is associated with high rates of induction failure and worse survival. Its presence places the patient into a high-risk group. We aimed to describe the outcome of pediatric AML with FLT3-ITD mutation. PATIENTS AND METHODS We performed a retrospective analysis of cases of AML from July 2007 till July 2017 at Children's Cancer Hospital Egypt. RESULTS Seventy-one patients had FLT3 gene mutation out of 687 patients with AML. Sixty-five patients had FLT3 gene mutation with allelic ratio > 0.4; 43 (66.1%) of 65 patients experienced complete remission (CR). Of the 43 patients, 16 patients maintained CR, 18 patients relapsed after first CR, 8 patients died, and 1 patient was lost to follow-up. Patients with relapsing disease died after salvage chemotherapy, except for one patient, who was alive after second CR. Allogeneic bone marrow transplantation (allo-BMT) was performed for 9 (13.8%) of 65 patients in first CR, of whom 8 were alive and in CR, and 1 patient experienced disease relapse and died. Seven patients (10.7%) were alive without allo-BMT. Three years' overall and event-free survival for patients with FLT3-ITD mutation with high allelic ratio was 26.9% and 22.8%, respectively. Three years' overall and event-free survival for patients treated with allo-BMT was 77.8% and 78.8%, respectively, versus patients treated without allo-BMT, 16.3% and 12.8%, respectively. CONCLUSION FLT3-ITD mutation in pediatric AML was associated with poor treatment outcomes, and the survival of relapsing patients was extremely poor. Allo-BMT in first remission was the best treatment option. Alternative donor transplants and FLT3 inhibitors are needed to improve outcome in developing countries.
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Affiliation(s)
- Samah Fathy Semary
- Department of Clinical Oncology, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt; Department of Pediatric Oncology, Children's Cancer Hospital Egypt, Cairo, Egypt.
| | - Mahmoud Hammad
- Department of Pediatric Oncology, Children's Cancer Hospital Egypt, Cairo, Egypt; Department of Pediatric Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Sonya Soliman
- Department of Clinical Pathology, National Cancer Institute, Cairo University, Cairo, Egypt; Department of Clinical Pathology, Children's Cancer Hospital Egypt, Cairo, Egypt
| | - Dina Yassen
- Department of Clinical Pathology, National Cancer Institute, Cairo University, Cairo, Egypt; Department of Clinical Pathology, Children's Cancer Hospital Egypt, Cairo, Egypt
| | - Marwa Gamal
- Department of Clinical Pharmacy, Children's Cancer Hospital Egypt, Cairo, Egypt
| | - Doaa Albeltagy
- Department of Clinical Research, Children's Cancer Hospital Egypt, Cairo, Egypt
| | - Nayera Hamdy
- Department of Clinical Pathology, National Cancer Institute, Cairo University, Cairo, Egypt; Department of Clinical Pathology, Children's Cancer Hospital Egypt, Cairo, Egypt
| | - Sonia Mahmoud
- Department of Pediatric Oncology, Children's Cancer Hospital Egypt, Cairo, Egypt; Department of Pediatric Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
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Modeling the Antileukemia Activity of Ellipticine-Related Compounds: QSAR and Molecular Docking Study. Molecules 2019; 25:molecules25010024. [PMID: 31861689 PMCID: PMC6982814 DOI: 10.3390/molecules25010024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/11/2019] [Accepted: 12/16/2019] [Indexed: 01/08/2023] Open
Abstract
The antileukemia cancer activity of organic compounds analogous to ellipticine representes a critical endpoint in the understanding of this dramatic disease. A molecular modeling simulation on a dataset of 23 compounds, all of which comply with Lipinski's rules and have a structure analogous to ellipticine, was performed using the quantitative structure activity relationship (QSAR) technique, followed by a detailed docking study on three different proteins significantly involved in this disease (PDB IDs: SYK, PI3K and BTK). As a result, a model with only four descriptors (HOMO, softness, AC1RABAMBID, and TS1KFABMID) was found to be robust enough for prediction of the antileukemia activity of the compounds studied in this work, with an R2 of 0.899 and Q2 of 0.730. A favorable interaction between the compounds and their target proteins was found in all cases; in particular, compounds 9 and 22 showed high activity and binding free energy values of around -10 kcal/mol. Theses compounds were evaluated in detail based on their molecular structure, and some modifications are suggested herein to enhance their biological activity. In particular, compounds 22_1, 22_2, 9_1, and 9_2 are indicated as possible new, potent ellipticine derivatives to be synthesized and biologically tested.
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