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Mawalla WF, Morrell L, Chirande L, Achola C, Mwamtemi H, Sandi G, Mahawi S, Kahakwa A, Ntemi P, Hadija N, Mkwizu E, Chamba C, Vavoulis D, Schuh A. Treatment delays in children and young adults with lymphoma: a report from an East Africa lymphoma cohort study. Blood Adv 2023; 7:4962-4965. [PMID: 37171463 PMCID: PMC10463187 DOI: 10.1182/bloodadvances.2022009398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 05/02/2023] [Accepted: 05/02/2023] [Indexed: 05/13/2023] Open
Affiliation(s)
- William Frank Mawalla
- AI-REAL Study, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Liz Morrell
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Lulu Chirande
- AI-REAL Study, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Caroline Achola
- AI-REAL Study, St Mary's Hospital Lacor, Gulu & African Field Epidemiology, Gulu-Uganda, Northern Region, Uganda
| | - Hadija Mwamtemi
- AI-REAL Study, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Godlove Sandi
- AI-REAL Study, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Salama Mahawi
- AI-REAL Study, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Atukuzwe Kahakwa
- AI-REAL Study, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Paul Ntemi
- AI-REAL Study, Bugando Medical Centre, Mwanza, Tanzania
| | - Nabalende Hadija
- AI-REAL Study, St Mary's Hospital Lacor, Gulu & African Field Epidemiology, Gulu-Uganda, Northern Region, Uganda
| | - Elifuraha Mkwizu
- AI-REAL Study, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Clara Chamba
- AI-REAL Study, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Dimitris Vavoulis
- AI-REAL Study, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Anna Schuh
- AI-REAL Study, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- AI-REAL Study, Department of Oncology, University of Oxford, Oxford, United Kingdom
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2
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Majaliwa E, Smith ER, Cotache-Condor C, Rice H, Gwanika Y, Canick J, Chao N, Schroeder K, Rice HE, Staton C, Mmbaga BT. Childhood and Adolescent Cancer Care at a Tertiary Hospital in Northern Tanzania: A Retrospective Study. JCO Glob Oncol 2023; 9:e2200263. [PMID: 37384861 PMCID: PMC10497254 DOI: 10.1200/go.22.00263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 03/17/2023] [Accepted: 05/08/2023] [Indexed: 07/01/2023] Open
Abstract
PURPOSE Over 400,000 children are diagnosed with cancer around the world each year, with over 80% of these children residing in low- and middle-income countries. This study aims to summarize the epidemiology and care patterns of newly diagnosed childhood cancer patients in Northern Tanzania. METHODS Data from all children and adolescents (age 0-19 years) with newly diagnosed cancers were collected from the Kilimanjaro Cancer Registry located at the Kilimanjaro Christian Medical Centre. Descriptive and inferential analyses were used to compare the demographic and clinical characteristics of the participants over time, stage, and status at last contact. Statistical significance was set at P < .05. Secondary descriptive analysis was conducted on a subset sample with available staging data. RESULTS A total of 417 patients were diagnosed with cancer between 2016 and 2021. There was an increase in the rate of patients with newly diagnosed pediatric cancer each year, particularly among children under age 5 years and 10 years. Leukemias and lymphomas were the leading diagnoses and accounted for 183 (43.8%) of all patients. Over 75% of patients were diagnosed at stage III or above. From a subset analysis of patients with available staging data (n = 101), chemotherapy was the most common treatment (87.1%), compared with radiotherapy and surgery. CONCLUSION There is a significant burden of children with cancer in Tanzania. Our study fills crucial gaps in the literature related to the large burden of disease and survival for children with cancer in the Kilimanjaro region. Furthermore, our results can be used to understand the regional needs and guide research and strategic interventions to improve childhood cancer survival in Northern Tanzania.
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Affiliation(s)
- Esther Majaliwa
- Pediatric Hematology and Oncology Services, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Emily R. Smith
- Department of Emergency Medicine, Duke University Medical Center, Durham, NC
- Duke Global Health Institute, Duke University, Durham, NC
| | - Cesia Cotache-Condor
- Duke Global Health Institute, Duke University, Durham, NC
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Hannah Rice
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Yotham Gwanika
- Kilimanjaro Cancer Registry, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Julia Canick
- Duke Global Health Institute, Duke University, Durham, NC
| | - Nelson Chao
- Department of Medicine, Duke University Medical Center, Durham, NC
| | - Kristin Schroeder
- Department of Oncology, Bugando Medical Centre, Mwanza, Tanzania
- Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - Henry E. Rice
- Duke Global Health Institute, Duke University, Durham, NC
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Catherine Staton
- Department of Emergency Medicine, Duke University Medical Center, Durham, NC
- Duke Global Health Institute, Duke University, Durham, NC
| | - Blandina T. Mmbaga
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
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3
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Dwivedi P, Kapse A, Bangurwar C, Tamhane A, Banavali S. Metronomic Chemotherapy for Burkitt Lymphoma in a Patient With HIV: Case Report. J Pediatr Hematol Oncol 2023; 45:78-81. [PMID: 36161878 DOI: 10.1097/mph.0000000000002547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 07/16/2022] [Indexed: 11/25/2022]
Abstract
Burkitt lymphoma (BL) is an aggressive type of non-Hodgkin lymphoma (NHL). With high-dose combination chemotherapy, cure rates are excellent. Treatment for HIV-positive BL is similar to that for HIV-negative BL. Offering long-term intensive chemotherapy is difficult in resource-limited settings. Oral metronomic chemotherapy, though in vogue as a treatment modality, has limited evidence of its efficacy in HIV-positive BL. Here, we present the case of a child who was diagnosed with BL and HIV and administered metronomic chemotherapy, and also review the literature on the role of metronomic chemotherapy in non-Hodgkin lymphoma with and without HIV.
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Affiliation(s)
| | | | | | | | - Shripad Banavali
- Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
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4
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Garcia-Quintero X, Cleves D, Cuervo MI, McNeil M, Salek M, Robertson EG, Gomez W, Baker JN, Kaye EC. Communication of Early Integration of Palliative Care for Children With Cancer in Latin America: The Care as a Vessel Metaphor. JCO Glob Oncol 2023; 9:e2200281. [PMID: 36595733 PMCID: PMC10166418 DOI: 10.1200/go.22.00281] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
| | - Daniela Cleves
- Department of Pediatrics, Hospital Universitario San Ignacio, Bogotá, Colombia
| | | | - Michael McNeil
- Department of Global Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Marta Salek
- Department of Global Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Eden G Robertson
- Department of Global Medicine, St Jude Children's Research Hospital, Memphis, TN.,Discipline of Paediatrics and Child Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Wendy Gomez
- Oncology Unit, Dr Robert Reid Cabral Children's Hospital, Santo Domingo, Dominican Republic
| | - Justin N Baker
- Department of Global Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Erica C Kaye
- Department of Global Medicine, St Jude Children's Research Hospital, Memphis, TN
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5
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Kang Y, Fang K, Wang M. Comprehensive analysis of clinicalf eatures, treatment options, overall survival, and prognostic factors in lymphoma cell leukemia patients: A retrospective study. J Cancer Res Ther 2022; 18:1961-1966. [PMID: 36647956 DOI: 10.4103/jcrt.jcrt_42_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Objective Lymphoma cell leukemia (LCL) is regarded as patients presenting a high extensive lymphoma cell ratio in bone marrow (BM), which is recognized as lymphoma of stage IV by invading into BM. This study aimed to investigate the clinical characteristics, treatment options, survival profiles, and prognostic factors in patients with LCL. Methods Clinical data of 42 patients with LCL were retrospectively reviewed, and baseline characteristics and treatment records were extracted. In addition, overall survival (OS) was calculated, and the causes of death were analyzed. Results Out of the 42 patients with LCL, 9 (21.4%) had primary BMLCL, 20 (47.6%) had Non-Hodgkin lymphoma (NHL) complicated with LCL, and 13 (31.0%) had NHL evolving into LCL. Common clinical characteristics included B syndromes (n = 21, 50.0%), abnormal white blood count (n = 28, 66.5%), decreased hemoglobin (n = 28, 66.7%), and platelet (n = 30, 71.4%). Additionally, elevated Eastern Cooperative Oncology Group (ECOG) with a score greater than one occurred in 26 patients (61.9%), and elevated lactate dehydrogenase (LDH) occurred in 25 patients (59.5%). For treatments, chemotherapy was the most common therapy (n = 35, 83.2%), followed by symptomatic treatment and radiotherapy plus chemotherapy. Additionally, the mean OS of the patients was 16.9 (95% CI: 12.8-20.9) months, among which primary patients with BMLCL showed shorter OS than those with NHL complicated with LCL and NHL evolving into patients with LCL. A total of 9 (21.4%) patients with LCL died during follow-up, among which the central nervous system (CNS) invasion was the most common cause of death. Furthermore, primary BMLCL, higher ECOG, and higher LDH were potential predictive factors for worse OS in patients with LCL. Conclusion This study gives an overview of the treatment and prognosis of LCL, which provides additional information for the management of LCL.
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Affiliation(s)
- Ya Kang
- Department of Hematology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Kun Fang
- Department of Sales, Kindstar Global, Wuhan, China
| | - Mengchang Wang
- Department of Hematology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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6
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van Heerden J, Balagadde-Kambugu J, Angom R, Lusobya RC, Chantada G, Desjardins L, Fabian ID, Israels T, Paintsil V, Hessissen L, Diouf MN, Elayadi M, Turner SD, Kouya F, Geel JA. Evaluating the baseline survival outcomes of the "six Global Initiative for Childhood Cancer index cancers" in Africa. Pediatr Hematol Oncol 2022; 40:203-223. [PMID: 36369884 DOI: 10.1080/08880018.2022.2140860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Limited survival data for the six Global Initiative for Childhood Cancer (GICC) priority cancers are available in Africa. Management of pediatric malignancies in Africa is challenging due to lack of resources, setting-specific comorbidities, high rates of late presentation and treatment abandonment. Reporting of outcome data is problematic due to the lack of registries. With the aim of evaluating the feasibility of baseline outcomes for the six index cancers, we present a descriptive analysis of respective survival rates in Africa. The survival rates were between 18% (lower middle-income countries) to 82.3% (upper middle-income countries) for acute lymphoblastic leukemia, between 26.9% (low-income countries) to 77.9% (upper middle-income countries) for nephroblastoma, between 23% (low-income countries) to 100% (upper middle-income countries), for retinoblastoma, 45% (low-income countries) to 95% (upper middle-income countries) for Hodgkin lymphoma and 28% (low-income countries) to 76% (upper middle-income countries) for Burkitt lymphoma. Solutions to improve survival rates and reported outcomes include establishing and funding sustainable registries, training and to actively include all countries in consortia from different African regions.HighlightsContinental differences in childhood cancer management such lack of resources, setting-specific comorbidities, high rates of late presentation and treatment abandonment, present challenges to the achievement of Global Initiative for Childhood Cancer goals.The available data registries do not adequately inform on the true incidences and outcomes of childhood cancers in Africa.The pathophysiology of some childhood cancers in Africa are associated with high-risk prognostic factors.Outcomes can be improved by greater regional collaboration to manage childhood cancer based on local resources and tumor characteristics.Some individual countries have reached the Global Initiative for Childhood Cancer goals for single cancers and it should be possible for more African countries to follow suit.
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Affiliation(s)
- Jaques van Heerden
- Pediatric Hematology and Oncology, Department of Pediatrics, Antwerp University Hospital, Antwerp, Belgium.,Pediatric hematology and Oncology, Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa.,Department of Pediatric Oncology, Uganda Cancer Institute, Kampala, Uganda
| | | | - Racheal Angom
- Department of Pediatric Oncology, Uganda Cancer Institute, Kampala, Uganda
| | - Rebecca Claire Lusobya
- Department of Ophthalmology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Guillermo Chantada
- Department of Pediatric Oncology, Hospital Sant Joan de Deu, Barcelona, Spain
| | | | - Ido Didi Fabian
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Tel-Aviv University, Tel-Aviv, Israel.,International Center for Eye Health London School of Hygiene and Tropical Medicine, London, UK
| | - Trijn Israels
- Department of Pediatrics, Queen Elizabeth Central Hospital, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Vivian Paintsil
- Department of Child Health, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Laila Hessissen
- Pediatric Hematology and Oncology Center, University Mohammed V Rabat, Rabat, Morocco
| | | | - Moatasem Elayadi
- Department of Pediatric Oncology, National Cancer Institute, Egypt & Children Cancer Hospital of Egypt (CCHE-57357), Cairo University, Giza, Egypt
| | | | - Francine Kouya
- Department of Pediatric Oncology, Cameroon Baptist Convention Hospitals in Mutengene, Mbingo and Banso, Mutengene, Cameroon
| | - Jennifer A Geel
- Division of Pediatric Hematology-Oncology, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Witwatersrand, South Africa
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7
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Rahiman EA, Bakhshi S, Deepam Pushpam, Ramamoorthy J, Das A, Ghara N, Kalra M, Kapoor G, Meena JP, Siddaigarhi S, Thulkar S, Sharma MC, Srinivasan R, Trehan A. Outcome and prognostic factors in childhood B non-Hodgkin lymphoma from India: Report by the Indian Pediatric Oncology Group (InPOG-NHL-16-01 study). Pediatr Hematol Oncol 2022; 39:391-405. [PMID: 34978257 DOI: 10.1080/08880018.2021.2002485] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The literature on B-non-Hodgkin lymphoma (NHL) in India is restricted to individual hospital data. The study aimed to evaluate the epidemiology and outcome of B-NHL in our country. One hundred and ninety-one patients of B-NHL from 10 centers diagnosed between 2013 and 2016 were analyzed retrospectively. B/T lymphoblastic lymphoma and patients with inadequate data were excluded. The median age was 88 months (IQR: 56, 144) with an M:F ratio of 5.6:1. Undernourishment and stunting were seen in 36.5% and 22%. Primary site was abdomen in 66.5%. Hypoalbuminemia was noted in 82/170 (48.2%). Histological subtypes: Burkitt lymphoma (BL): 69.6%, Burkitt-like: 10.4%, and diffuse large B cell lymphoma (DLBCL): 13.6%, unclassified and others (6.4%). Stage distribution: I/II, 33 (17.3%), III, 114 (59.7%), and IV, 44 (23%). One-eighty-six patients took treatment. Protocols used were LMB and BFM in 160/186 (86%). At a median follow-up of 21.34 (IQR: 4.34, 36.57) months, the disease-free-survival (DFS) was 74.4% and event-free-survival (EFS) was 60.7%. Treatment-related mortality (TRM), relapse/progression and abandonment were 14.3%, 14.5%, and 8.4%, respectively. Bone marrow positivity, stage IV disease, and lactate dehydrogenase (LDH) > 2,000 U/l predicted inferior EFS. Stage IV disease, LDH > 2,000 U/l, bone marrow positivity, tumor lysis syndrome and low albumin predicted TRM; LDH retained significance on multivariate analysis for EFS and TRM [OR: 4.54, 95% CI: 1.14-20, p 0.03; OR 20, 95%CI: 1.69-250, p 0.017]. BL was the main histological subtype. High TRM and relapse/progression are hampering survival. An LDH > 2,000 U/l was adversely prognostic. These data demonstrate a need to develop a national protocol that balances toxicity and potential for cure.
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Affiliation(s)
- Emine A Rahiman
- Pediatric Hematology-Oncology Unit and Cytology Department, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sameer Bakhshi
- Rotary Cancer Institute, All India Institute of Medical Sciences, New Delhi, India
| | - Deepam Pushpam
- Rotary Cancer Institute, All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | | | | | - Jagdish Prasad Meena
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Sanjay Thulkar
- Rotary Cancer Institute, All India Institute of Medical Sciences, New Delhi, India
| | - Meher Chand Sharma
- Rotary Cancer Institute, All India Institute of Medical Sciences, New Delhi, India
| | - Radhika Srinivasan
- Pediatric Hematology-Oncology Unit and Cytology Department, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amita Trehan
- Pediatric Hematology-Oncology Unit and Cytology Department, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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8
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Moleti ML, Testi AM, Foà R. Childhood aggressive B-cell non-Hodgkin lymphoma in low-middle-income countries. Br J Haematol 2021; 196:849-863. [PMID: 34866182 DOI: 10.1111/bjh.17979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/04/2021] [Accepted: 11/17/2021] [Indexed: 11/28/2022]
Abstract
In high-income countries (HICs) paediatric aggressive B-cell lymphomas are curable in about 90% of cases. Much worse results, with cure rates ranging from less than 30% to about 70%, are achieved in low- and middle-income countries (LMICs), where 90% of paediatric non-Hodgkin lymphomas occur. Low socio-economic and cultural conditions, the lack of optimal diagnostic procedures, laboratory facilities and adequate supportive care exert a strong negative impact on compliance, treatment delivery, toxicity and, consequently, on the clinical outcome. Published data are scarce, generally originating from single institutions, and are difficult to compare. National and international cooperation projects have been undertaken to reduce the unacceptable gap between HICs and LMICs in the management of children with cancer, by promoting the sharing of knowledge and by implementing adequate local healthcare facilities, with initial promising results. In the present review, we will summarize the results so far obtained in the management of paediatric aggressive B-cell NHL in LMICs.
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Affiliation(s)
- Maria Luisa Moleti
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Anna Maria Testi
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
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9
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Five decades of low intensity and low survival: adapting intensified regimens to cure pediatric Burkitt lymphoma in Africa. Blood Adv 2021; 4:4007-4019. [PMID: 32841337 DOI: 10.1182/bloodadvances.2020002178] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/14/2020] [Indexed: 02/07/2023] Open
Abstract
Long-term cure of childhood Burkitt lymphoma (BL) in sub-Saharan Africa after treatment with single-agent cyclophosphamide has been documented for more than half of a century. Contemporary cure rates for the highest-risk patients with BL in high-income countries exceed 90% using intensive multiagent chemotherapy. By contrast, the majority of African children with BL still die. Data spanning 5 decades in Africa have repeatedly shown that the children most likely to achieve cure with limited cyclophosphamide regimens are those with lower-stage disease isolated to the jaw. Attempts to intensify the cyclophosphamide monotherapy backbone with the addition of vincristine, low-dose methotrexate, prednisone, doxorubicin, and/or low-dose cytarabine have not yielded significant improvement. High-dose methotrexate is a critical component in the treatment of childhood BL worldwide. Although initial efforts in Africa to incorporate high-dose methotrexate resulted in high treatment-related mortality, more recent collaborative experiences from North and West Africa, as well as Central America, demonstrate that it can be administered safely and effectively, despite limitations in supportive care resources. Recognizing the unacceptable disparity in curative outcomes for BL between the United States/Europe and equatorial Africa, there is a critical need to safely adapt contemporary treatment regimens to optimize curative outcomes amid the resource limitations in regions where BL is endemic. Here, we critically review reports of BL treatment outcomes from low- and middle-income countries, in addition to data from high-income countries that predated modern intensified regimens, to identify potential strategies to improve the therapeutic approach for children suffering from BL in sub-Saharan Africa.
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10
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Volaric AK, Singh K, Gru AA. Rare EBV-associated B cell neoplasms of the gastrointestinal tract. Semin Diagn Pathol 2021; 38:38-45. [PMID: 33985830 DOI: 10.1053/j.semdp.2021.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 04/04/2021] [Accepted: 04/21/2021] [Indexed: 12/20/2022]
Abstract
EBV-driven B cell neoplasms can rarely present as an extranodal mass in the gastrointestinal tract and can be missed, even by experienced pathologists, because of this uncommon presentation. A selection of these neoplasms, namely EBV-positive diffuse large B cell lymphoma, not otherwise specified (DLBCL NOS), EBV-positive mucocutaneous ulcer (EBV MCU), extracavitary primary effusion lymphoma (EPEL), and EBV-positive Burkitt lymphoma, will be discussed in the present review. Besides the common thread of EBV positivity, these lymphoproliferative disorders arise in unique clinical settings that are often associated with immunodeficiency, immunosuppression or immunosenescence and can present as solitary masses albeit rarely, within the gastrointestinal tract.
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Affiliation(s)
- Ashley K Volaric
- Department of Pathology, Stanford Medicine, Stanford, CA, United States
| | - Kunwar Singh
- Department of Pathology, Stanford Medicine, Stanford, CA, United States
| | - Alejandro A Gru
- Department of Pathology, University of Virginia, Charlottesville, VA, United States.
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11
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Gupta S, Hunger SP. Recent trends in the results of studies conducted by the Children’s Oncology Group acute lymphoblastic leukemia committee and implications for emerging cooperative trial groups in low- and middle-income countries. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2020. [DOI: 10.1016/j.phoj.2020.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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12
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Bouda GC, Traoré F, Couitchere L, Raquin MA, Guedenon KM, Pondy A, Moreira C, Rakotomahefa M, Harif M, Patte C. Advanced Burkitt Lymphoma in Sub-Saharan Africa Pediatric Units: Results of the Third Prospective Multicenter Study of the Groupe Franco-Africain d'Oncologie Pédiatrique. J Glob Oncol 2020; 5:1-9. [PMID: 31794283 PMCID: PMC6939747 DOI: 10.1200/jgo.19.00172] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To evaluate the results of an intensive polychemotherapy regimen for Burkitt lymphoma (BL) in sub-Saharan African pediatric centers. PATIENTS AND METHODS Children with advanced-stage BL (stages II bulky, III, and IV) treated with the GFAOP–Lymphomes Malins B (GFALMB) 2009 protocol in 7 centers between April 2009 and September 2015 were prospectively registered. Treatment regimen contained a prephase with cyclophosphamide followed by 2 induction courses (cyclophosphamide, vincristine, prednisone, high-dose methotrexate [HDMTX]), 2 consolidation courses (cytarabine, HDMTX), and a maintenance phase only for stage IV. HDMTX was given at the dose of 3 g/m2. RESULTS Four hundred patients were analyzed: 7% had stage II bulky, 76% stage III, and 17% stage IV disease. Median age was 7.3 years, and sex ratio was 1.9:1 (male:female). A total of 221 patients received the whole protocol treatment and 195 achieved complete remission (CR), 11 of them after a second-line treatment. Treatment abandonment rate was 22%. One hundred twenty-five patients died, of whom 49 deaths were related to treatment toxicity. A total of 275 patients are alive, including 25 despite treatment abandonment, but only 110 are known to be in CR with a follow-up > 1 year, indicating a high rate of loss to follow-up. Twelve-month overall survival (OS) was 60% (95% CI, 54% to 66%) and 63%, 60%, and 31%, respectively, for stage II bulky, III, and IV. Patients with stage III disease who started second induction course within 34 days had OS of 76%, versus 57% (P = .0062) beyond 34 days. CONCLUSION The GFA-LMB2009 protocol improved patients’ survival. Early dose intensity of treatment is a strong prognostic factor. Improving supportive care and decreasing loss to follow-up are crucial.
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Affiliation(s)
| | | | | | - Marie-Anne Raquin
- Gustave Roussy Hospital and GFAOP Database Center, Villejuif, France
| | | | - Angele Pondy
- Centre Mère-Enfant, Fondation Chantal Biya, Yaoundé, Cameroun
| | | | | | | | - Catherine Patte
- Gustave Roussy Hospital and GFAOP Database Center, Villejuif, France
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13
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Granai M, Mundo L, Akarca AU, Siciliano MC, Rizvi H, Mancini V, Onyango N, Nyagol J, Abinya NO, Maha I, Margielewska S, Wi W, Bibas M, Piccaluga PP, Quintanilla-Martinez L, Fend F, Lazzi S, Leoncini L, Marafioti T. Immune landscape in Burkitt lymphoma reveals M2-macrophage polarization and correlation between PD-L1 expression and non-canonical EBV latency program. Infect Agent Cancer 2020; 15:28. [PMID: 32391073 PMCID: PMC7201729 DOI: 10.1186/s13027-020-00292-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 04/20/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The Tumor Microenviroment (TME) is a complex milieu that is increasingly recognized as a key factor in multiple stages of disease progression and responses to therapy as well as escape from immune surveillance. However, the precise contribution of specific immune effector and immune suppressor components of the TME in Burkitt lymphoma (BL) remains poorly understood. METHODS In this paper, we applied the computational algorithm CIBERSORT to Gene Expression Profiling (GEP) datasets of 40 BL samples to draw a map of immune and stromal components of TME. Furthermore, by multiple immunohistochemistry (IHC) and multispectral immunofluorescence (IF), we investigated the TME of additional series of 40 BL cases to evaluate the role of the Programmed Death-1 and Programmed Death Ligand-1 (PD-1/PD-L1) immune checkpoint axis. RESULTS Our results indicate that M2 polarized macrophages are the most prominent TME component in BL. In addition, we investigated the correlation between PD-L1 and latent membrane protein-2A (LMP2A) expression on tumour cells, highlighting a subgroup of BL cases characterized by a non-canonical latency program of EBV with an activated PD-L1 pathway. CONCLUSION In conclusion, our study analysed the TME in BL and identified a tolerogenic immune signature highlighting new potential therapeutic targets.
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Affiliation(s)
- Massimo Granai
- Department of Medical Biotechnology, University of Siena, Siena, Italy
- University Hospital of Tübingen, Institute of Pathology, Tübingen, Germany
| | - Lucia Mundo
- Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - Ayse U. Akarca
- Department of Pathology, University College London, London, UK
| | | | - Hasan Rizvi
- Department of Cellular Pathology, Barts Health NHS Trust, London, UK
| | - Virginia Mancini
- Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - Noel Onyango
- Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya
| | - Joshua Nyagol
- Department of Human Pathology, University of Nairobi, Nairobi, Kenya
| | | | - Ibrahim Maha
- South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Sandra Margielewska
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK and Durham University, Durham, UK
| | - Wenbin Wi
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK and Durham University, Durham, UK
| | - Michele Bibas
- Clinical Department, National Institute for Infectious Diseases “Lazzaro Spallanzani” I.R.C.C.S, Rome, Italy
| | - Pier Paolo Piccaluga
- Department of Experimental, Diagnostic, and Specialty Medicine Bologna University Medical School, S. Orsola Malpighi Hospital, Bologna and Euro-Mediterranean Institute of Science and Technology (IEMEST), Palermo, Italy
| | | | - Falko Fend
- University Hospital of Tübingen, Institute of Pathology, Tübingen, Germany
| | - Stefano Lazzi
- Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - Lorenzo Leoncini
- Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - Teresa Marafioti
- Department of Pathology, University College London, London, UK
- Department of Cellular Pathology, University College Hospital, London, London UK
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14
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Atun R, Bhakta N, Denburg A, Frazier AL, Friedrich P, Gupta S, Lam CG, Ward ZJ, Yeh JM, Allemani C, Coleman MP, Di Carlo V, Loucaides E, Fitchett E, Girardi F, Horton SE, Bray F, Steliarova-Foucher E, Sullivan R, Aitken JF, Banavali S, Binagwaho A, Alcasabas P, Antillon F, Arora RS, Barr RD, Bouffet E, Challinor J, Fuentes-Alabi S, Gross T, Hagander L, Hoffman RI, Herrera C, Kutluk T, Marcus KJ, Moreira C, Pritchard-Jones K, Ramirez O, Renner L, Robison LL, Shalkow J, Sung L, Yeoh A, Rodriguez-Galindo C. Sustainable care for children with cancer: a Lancet Oncology Commission. Lancet Oncol 2020; 21:e185-e224. [PMID: 32240612 DOI: 10.1016/s1470-2045(20)30022-x] [Citation(s) in RCA: 160] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/22/2019] [Accepted: 01/14/2020] [Indexed: 12/29/2022]
Abstract
We estimate that there will be 13·7 million new cases of childhood cancer globally between 2020 and 2050. At current levels of health system performance (including access and referral), 6·1 million (44·9%) of these children will be undiagnosed. Between 2020 and 2050, 11·1 million children will die from cancer if no additional investments are made to improve access to health-care services or childhood cancer treatment. Of this total, 9·3 million children (84·1%) will be in low-income and lower-middle-income countries. This burden could be vastly reduced with new funding to scale up cost-effective interventions. Simultaneous comprehensive scale-up of interventions could avert 6·2 million deaths in children with cancer in this period, more than half (56·1%) of the total number of deaths otherwise projected. Taking excess mortality risk into consideration, this reduction in the number of deaths is projected to produce a gain of 318 million life-years. In addition, the global lifetime productivity gains of US$2580 billion in 2020-50 would be four times greater than the cumulative treatment costs of $594 billion, producing a net benefit of $1986 billion on the global investment: a net return of $3 for every $1 invested. In sum, the burden of childhood cancer, which has been grossly underestimated in the past, can be effectively diminished to realise massive health and economic benefits and to avert millions of needless deaths.
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Affiliation(s)
- Rifat Atun
- Department of Global health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston MA, USA.
| | - Nickhill Bhakta
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Avram Denburg
- Division of Haematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - A Lindsay Frazier
- Dana-Farber and Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | - Paola Friedrich
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Sumit Gupta
- Division of Haematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Catherine G Lam
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Zachary J Ward
- Center for Health Decision Science, Harvard T H Chan School of Public Health, Harvard University, Boston MA, USA
| | - Jennifer M Yeh
- Department of Pediatrics, Harvard Medical School, Harvard University, Boston MA, USA; Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Claudia Allemani
- Cancer Survival Group, Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Michel P Coleman
- Cancer Survival Group, Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Veronica Di Carlo
- Cancer Survival Group, Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Elizabeth Fitchett
- University College London Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Fabio Girardi
- Cancer Survival Group, Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Susan E Horton
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, WHO, Lyon, France
| | - Eva Steliarova-Foucher
- Section of Cancer Surveillance, International Agency for Research on Cancer, WHO, Lyon, France
| | - Richard Sullivan
- Institute of Cancer Policy, Conflict and Health Research Group, School of Cancer Sciences, King's College London, London, UK
| | - Joanne F Aitken
- Cancer Council Queensland, Brisbane, QLD, Australia; School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Shripad Banavali
- Department of Medical and Pediatric Oncology, Tata Memorial Center, Mumbai, India; Homi Bhabha National Institute, Mumbai, India
| | | | - Patricia Alcasabas
- Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Federico Antillon
- Unidad Nacional de Oncología Pediátrica and the School of Medicine, Universidad Francisco Marroquín, Guatemala City, Guatemala
| | - Ramandeep S Arora
- Department of Medical Oncology, Max Super-Specialty Hospital, New Delhi, India
| | - Ronald D Barr
- Departments of Pediatrics, Pathology and Medicine, Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Eric Bouffet
- Division of Haematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Julia Challinor
- School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | | | - Thomas Gross
- Center for Global Health, US National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lars Hagander
- Department of Clinical Sciences Lund, Pediatric Surgery, WHO Collaborating Centre for Surgery and Public Health, Lund University Faculty of Medicine, Lund, Sweden
| | - Ruth I Hoffman
- American Childhood Cancer Organization, Beltsville, MD, USA
| | - Cristian Herrera
- Health Division, Organization for Economic Cooperation and Development, Paris, France; Department of Public Health, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Tezer Kutluk
- Department of Pediatrics, Division of Pediatric Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey; Cancer Institute, Hacettepe University, Ankara, Turkey
| | - Karen J Marcus
- Department of Radiation Oncology, Harvard Medical School, Harvard University, Boston MA, USA; Division of Radiation Oncology, Boston Children's Hospital, Boston, MA, USA
| | - Claude Moreira
- Institut Jean Lemerle, African Paediatric Oncology Formation, Dakar, Senegal; Hôpital Aristide Le Dantec, Université Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Kathy Pritchard-Jones
- University College London Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Oscar Ramirez
- Department of Pediatric Haematology and Oncology, Centro Médico Imbanaco de Cali, Cali, Colombia; Cali Cancer Population-based Registry, Universidad del Valle, Cali, Colombia
| | - Lorna Renner
- Department of Child Health, University of Ghana Medical School Accra, Ghana; Paediatric Oncology Unit, Korle Bu Teaching Hospital, Accra, Ghana
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Jaime Shalkow
- Department of Pediatric Surgical Oncology, National Institute of Pediatrics, Mexico City, Mexico; School of Medicine, Anahuac University, Mexico City, Mexico
| | - Lillian Sung
- Division of Haematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Allen Yeoh
- Division of Paediatric Haematology and Oncology, National University Cancer Institute, Singapore National University Health System, Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Carlos Rodriguez-Galindo
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA.
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15
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Vasudevan L, Schroeder K, Raveendran Y, Goel K, Makarushka C, Masalu N, Zullig LL. Using digital health to facilitate compliance with standardized pediatric cancer treatment guidelines in Tanzania: protocol for an early-stage effectiveness-implementation hybrid study. BMC Cancer 2020; 20:254. [PMID: 32223740 PMCID: PMC7104518 DOI: 10.1186/s12885-020-6611-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 02/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background In high-income countries (HICs), increased rates of survival among pediatric cancer patients are achieved through the use of protocol-driven treatment. Compared to HICs, differences in infrastructure, supportive care, and human resources, make compliance with protocol-driven treatment challenging in low- and middle-income countries (LMICs). For successful implementation of protocol-driven treatment, treatment protocols must be resource-adapted for the LMIC context, and additional supportive tools must be developed to promote protocol compliance. In Tanzania, an LMIC where resource-adapted treatment protocols are available, digital health applications could promote protocol compliance through incorporation of systematic decision support algorithms, reminders and alerts related to patient visits, and up-to-date data for care coordination. However, evidence on the use of digital health applications in improving compliance with protocol-driven treatment for pediatric cancer is limited. This study protocol describes the development and evaluation of a digital health application, called mNavigator, to facilitate compliance with protocol-driven treatment for pediatric cancer in Tanzania. Methods mNavigator is a digital case management system that incorporates nationally-approved and resource-adapted treatment protocols for two pediatric cancers in Tanzania, Burkitt lymphoma and retinoblastoma. mNavigator is developed from an open-source digital health platform, called CommCare, and guided by the Consolidated Framework for Implementation Research. From July 2019–July 2020 at Bugando Medical Centre in Mwanza, Tanzania, all new pediatric cancer patients will be registered and managed using mNavigator as the new standard of care for patient intake and outcome assessment. Pediatric cancer patients with a clinical diagnosis of Burkitt lymphoma or retinoblastoma will be approached for participation in the study evaluating mNavigator. mNavigator users will document pre-treatment and treatment details for study participants using digital forms and checklists that facilitate compliance with protocol-driven treatment. Compliance with treatment protocols using mNavigator will be compared to historical compliance rates as the primary outcome. Throughout the implementation period, we will document factors that facilitate or inhibit mNavigator implementation. Discussion Study findings will inform implementation and scale up of mNavigator in tertiary pediatric cancer facilities in Tanzania, with the goal of facilitating protocol-driven treatment. Trial registration The study protocol was registered in ClinicalTrials.gov (NCT03677128) on September 19, 2018.
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Affiliation(s)
- Lavanya Vasudevan
- Department of Family Medicine and Community Health, Duke School of Medicine, 2200 W. Main Street, Durham, NC, 27710, USA. .,Duke Global Health Institute, 310 Trent Drive, Durham, NC, 27710, USA.
| | - Kristin Schroeder
- Duke Global Health Institute, 310 Trent Drive, Durham, NC, 27710, USA.,Department of Pediatrics, Division of Hematology/Oncology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC, 27710, USA.,Bugando Medical Centre, Wurtzburg Road, Mwanza, Tanzania
| | | | - Kunal Goel
- Duke School of Medicine, 8 Searle Center Drive, Durham, NC, 27710, USA
| | - Christina Makarushka
- Department of Family Medicine and Community Health, Duke School of Medicine, 2200 W. Main Street, Durham, NC, 27710, USA
| | - Nestory Masalu
- Bugando Medical Centre, Wurtzburg Road, Mwanza, Tanzania
| | - Leah L Zullig
- Department of Population Health Sciences, 215 Morris St, Durham, NC, 27701, USA.,Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, 508 Fulton St, Durham, NC, 27705, USA
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16
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Cheerathodi MR, Meckes DG. The Epstein-Barr virus LMP1 interactome: biological implications and therapeutic targets. Future Virol 2018; 13:863-887. [PMID: 34079586 DOI: 10.2217/fvl-2018-0120] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The oncogenic potential of Epstein-Barr virus (EBV) is mostly attributed to latent membrane protein 1 (LMP1), which is essential and sufficient for transformation of fibroblast and primary lymphocytes. LMP1 expression results in the activation of multiple signaling cascades like NF-ΚB and MAP kinases that trigger cell survival and proliferative pathways. LMP1 specific signaling events are mediated through the recruitment of a number of interacting proteins to various signaling domains. Based on these properties, LMP1 is an attractive target to develop effective therapeutics to treat EBV-related malignancies. In this review, we focus on LMP1 interacting proteins, associated signaling events, and potential targets that could be exploited for therapeutic strategies.
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Affiliation(s)
- Mujeeb R Cheerathodi
- Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, FL, 32306
| | - David G Meckes
- Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, FL, 32306
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17
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Schroeder K, Saxton A, McDade J, Chao C, Masalu N, Chao C, Wechsler DS, Likonda B, Chao N. Pediatric Cancer in Northern Tanzania: Evaluation of Diagnosis, Treatment, and Outcomes. J Glob Oncol 2018; 4:1-10. [PMID: 30241177 PMCID: PMC6180837 DOI: 10.1200/jgo.2016.009027] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE The majority of new diagnoses of pediatric cancer are made in resource-poor countries, where survival rates range from 5% to 25% compared with 80% in high-resource countries. Multiple factors, including diagnostic and treatment capacities and complex socioeconomic factors, contribute to this variation. This study evaluated the available resources and outcomes for pediatric patients with cancer at the first oncology treatment center in northern Tanzania. METHODS Qualitative interviews were completed from July to August 2015 to determine available staff, hospital, diagnostic, treatment, and supportive care resources. A retrospective review of hospital admissions and clinic visits from January 2010 to August 2014 was completed. A total of 298 patients were identified, and data from 182 patient files were included in this review. RESULTS Diagnostic, treatment, and supportive capacities are limited for pediatric cancer care. The most common diagnoses were Burkitt lymphoma (n = 32), other non-Hodgkin lymphoma (n = 26), and Wilms tumor (n = 25). A total of 40% of patients (n = 72) abandoned care. There was a 20% 2-year event-free survival rate, which was significantly affected by patient age, method of diagnosis, and year of diagnosis. CONCLUSION To our knowledge, this is the first review of pediatric cancer outcomes in northern Tanzania. The study identified areas for future development to improve pediatric cancer outcomes, which included strengthening of training and diagnostic capacities, development of registries and research databases, and the need for additional research to reduce treatment abandonment.
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Affiliation(s)
- Kristin Schroeder
- Kristin Schroeder, Anthony Saxton, Christina Chao, Daniel S. Wechsler, and Nelson Chao, Duke University, Durham, NC; Jessica McDade, Seattle Children's, Seattle, WA; Nestory Masalu and Beda Likonda, Bugando Medical Centre, Mwanza, Tanzania; and Colin Chao, Eastern Virginia Medical School, Norfolk, VA
| | - Anthony Saxton
- Kristin Schroeder, Anthony Saxton, Christina Chao, Daniel S. Wechsler, and Nelson Chao, Duke University, Durham, NC; Jessica McDade, Seattle Children's, Seattle, WA; Nestory Masalu and Beda Likonda, Bugando Medical Centre, Mwanza, Tanzania; and Colin Chao, Eastern Virginia Medical School, Norfolk, VA
| | - Jessica McDade
- Kristin Schroeder, Anthony Saxton, Christina Chao, Daniel S. Wechsler, and Nelson Chao, Duke University, Durham, NC; Jessica McDade, Seattle Children's, Seattle, WA; Nestory Masalu and Beda Likonda, Bugando Medical Centre, Mwanza, Tanzania; and Colin Chao, Eastern Virginia Medical School, Norfolk, VA
| | - Christina Chao
- Kristin Schroeder, Anthony Saxton, Christina Chao, Daniel S. Wechsler, and Nelson Chao, Duke University, Durham, NC; Jessica McDade, Seattle Children's, Seattle, WA; Nestory Masalu and Beda Likonda, Bugando Medical Centre, Mwanza, Tanzania; and Colin Chao, Eastern Virginia Medical School, Norfolk, VA
| | - Nestory Masalu
- Kristin Schroeder, Anthony Saxton, Christina Chao, Daniel S. Wechsler, and Nelson Chao, Duke University, Durham, NC; Jessica McDade, Seattle Children's, Seattle, WA; Nestory Masalu and Beda Likonda, Bugando Medical Centre, Mwanza, Tanzania; and Colin Chao, Eastern Virginia Medical School, Norfolk, VA
| | - Colin Chao
- Kristin Schroeder, Anthony Saxton, Christina Chao, Daniel S. Wechsler, and Nelson Chao, Duke University, Durham, NC; Jessica McDade, Seattle Children's, Seattle, WA; Nestory Masalu and Beda Likonda, Bugando Medical Centre, Mwanza, Tanzania; and Colin Chao, Eastern Virginia Medical School, Norfolk, VA
| | - Daniel S Wechsler
- Kristin Schroeder, Anthony Saxton, Christina Chao, Daniel S. Wechsler, and Nelson Chao, Duke University, Durham, NC; Jessica McDade, Seattle Children's, Seattle, WA; Nestory Masalu and Beda Likonda, Bugando Medical Centre, Mwanza, Tanzania; and Colin Chao, Eastern Virginia Medical School, Norfolk, VA
| | - Beda Likonda
- Kristin Schroeder, Anthony Saxton, Christina Chao, Daniel S. Wechsler, and Nelson Chao, Duke University, Durham, NC; Jessica McDade, Seattle Children's, Seattle, WA; Nestory Masalu and Beda Likonda, Bugando Medical Centre, Mwanza, Tanzania; and Colin Chao, Eastern Virginia Medical School, Norfolk, VA
| | - Nelson Chao
- Kristin Schroeder, Anthony Saxton, Christina Chao, Daniel S. Wechsler, and Nelson Chao, Duke University, Durham, NC; Jessica McDade, Seattle Children's, Seattle, WA; Nestory Masalu and Beda Likonda, Bugando Medical Centre, Mwanza, Tanzania; and Colin Chao, Eastern Virginia Medical School, Norfolk, VA
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18
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How I treat Burkitt lymphoma in children, adolescents, and young adults in sub-Saharan Africa. Blood 2018; 132:254-263. [PMID: 29769263 DOI: 10.1182/blood-2018-04-844472] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 05/14/2018] [Indexed: 12/16/2022] Open
Abstract
Burkitt lymphoma (BL) is the most common pediatric cancer in sub-Saharan Africa (SSA), and also occurs frequently among adolescents and young adults (AYAs), often associated with HIV. Treating BL in SSA poses particular challenges. Although highly effective, high-intensity cytotoxic treatments used in resource-rich settings are usually not feasible, and lower-intensity continuous infusion approaches are impractical. In this article, based on evidence from the region, we review management strategies for SSA focused on diagnosis and use of prephase and definitive treatment. Additionally, potentially better approaches for risk stratification and individualized therapy are elaborated. Compared with historical very low-intensity approaches, the relative safety, feasibility, and outcomes of regimens incorporating anthracyclines and/or high-dose systemic methotrexate for this population are discussed, along with requirements to administer such regimens safely. Finally, research priorities for BL in SSA are outlined including novel therapies, to reduce the unacceptable gap in outcomes for patients in SSA vs high-income countries (HICs). Sustained commitment to incremental advances and innovation, as in cooperative pediatric oncology groups in HICs, is required to transform care and outcomes for BL in SSA through international collaboration.
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19
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Differential IgM expression distinguishes two types of pediatric Burkitt lymphoma in mouse and human. Oncotarget 2018; 7:63504-63513. [PMID: 27566574 PMCID: PMC5325380 DOI: 10.18632/oncotarget.11531] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 08/13/2016] [Indexed: 11/25/2022] Open
Abstract
Endemic Burkitt lymphoma (eBL) is primarily a childhood cancer in parts of Africa and Brazil. Classic studies describe eBL as a homogeneous entity based on t(8;14) IgH-Myc translocation and clinical response to cytotoxic therapy. By contrast, sporadic BL (sBL) in Western countries is considered more heterogeneous, and affects both children and adults. It is overrepresented in AIDS patients. Unlike diffuse large B cell lymphoma (DLBCL), molecular subtypes within BL have not been well defined. We find that differential IgM positivity can be used to describe two subtypes of pediatric Burkitt lymphoma both in a high incidence region (Brazil), as well as in a sporadic region (US), suggesting the phenotype is not necessarily geographically isolated. Moreover, we find that IgM positivity also distinguishes between early and late onset BL in the standard Eμ-Myc mouse model of BL. This suggests that the t(8;14) translocation not only can take place before, but also after isotype switch recombination, and that IgM-negative, t(8;14) positive lymphomas in children should nevertheless be considered BL.
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20
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Tomoka T, Montgomery ND, Powers E, Dhungel BM, Morgan EA, Mulenga M, Gopal S, Fedoriw Y. Lymphoma and Pathology in Sub-Saharan Africa: Current Approaches and Future Directions. Clin Lab Med 2018; 38:91-100. [PMID: 29412887 PMCID: PMC5999328 DOI: 10.1016/j.cll.2017.10.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The care of patients with lymphoma relies heavily on accurate tissue diagnosis and classification. In sub-Saharan Africa, where lymphoma burden is increasing because of population growth, aging, and continued epidemic levels of human immunodeficiency virus infection, diagnostic pathology services are limited. This article summarizes lymphoma epidemiology, current diagnostic capacity, and obstacles and opportunities for improving practice in the region.
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Affiliation(s)
- Tamiwe Tomoka
- UNC Project Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | - Nathan D Montgomery
- Department of Pathology and Laboratory Medicine, The University of North Carolina School of Medicine, CB 7525, Chapel Hill, NC 27599-7525, USA
| | - Eric Powers
- Department of Pathology and Laboratory Medicine, The University of North Carolina School of Medicine, CB 7525, Chapel Hill, NC 27599-7525, USA
| | | | - Elizabeth A Morgan
- Brigham and Women's Hospital, 75 Francis Street, Amory Building, Boston, MA 02115, USA
| | | | - Satish Gopal
- UNC Project Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi; Lineberger Comprehensive Cancer Center, CB 7295, Chapel Hill, NC 27599-7295, USA
| | - Yuri Fedoriw
- Department of Pathology and Laboratory Medicine, The University of North Carolina School of Medicine, CB 7525, Chapel Hill, NC 27599-7525, USA; Lineberger Comprehensive Cancer Center, CB 7295, Chapel Hill, NC 27599-7295, USA.
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21
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Martijn HA, Njuguna F, Olbara G, Langat S, Skiles J, Martin S, Vik T, van de Ven PM, Kaspers GJ, Mostert S. Influence of health insurance status on paediatric non-Hodgkin's lymphoma treatment in Kenya. BMJ Paediatr Open 2017; 1:e000149. [PMID: 29637157 PMCID: PMC5862191 DOI: 10.1136/bmjpo-2017-000149] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/05/2017] [Accepted: 07/06/2017] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Non-Hodgkin's lymphoma (NHL) is the most common childhood malignancy in sub-Saharan Africa. Survival rates for NHL are higher than 80% in high-income countries.This study explores treatment outcomes of children with NHL in Kenya, a sub-Saharan low-income country, and the association between health insurance status at diagnosis and treatment outcomes. DESIGN This was a retrospective medical records study. All children diagnosed with NHL in 2010, 2011 and 2012 were included. Data on treatment outcomes and health insurance status at diagnosis were collected. RESULTS Of all 63 patients with NHL, 35% abandoned treatment, 22% had progressive or relapsed disease, 14% died and 29% had event-free survival. Most patients (73%) had no health insurance at diagnosis. Treatment outcomes in children with or without health insurance at diagnosis differed significantly (p=0.005). The most likely treatment outcome in children with health insurance at diagnosis was event-free survival (53%), whereas in children without health insurance at diagnosis it was abandonment of treatment (44%). Crude HR for treatment failure was 3.1 (95% CI 1.41 to 6.60, p=0.005) for uninsured versus insured children. The event-free survival estimate was significantly higher in children with health insurance at diagnosis than in patients without health insurance at diagnosis (p=0.003). Stage of disease at diagnosis was identified as a confounder of this association (adjusted HR=2.4, 95% CI 0.95 to 6.12, p=0.063). CONCLUSIONS Survival of children with NHL in Kenya is much lower compared with high-income countries. Abandonment of treatment is the most common cause of treatment failure. Health insurance at diagnosis was associated with better treatment outcomes and survival.
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Affiliation(s)
- Hugo A Martijn
- Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - Festus Njuguna
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Gilbert Olbara
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Sandra Langat
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Jodi Skiles
- Department of Pediatrics, Division of Hemato-Oncology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Stephen Martin
- Department of Pediatrics, Division of Hemato-Oncology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Terry Vik
- Department of Pediatrics, Division of Hemato-Oncology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Gertjan Jl Kaspers
- Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Saskia Mostert
- Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, The Netherlands
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22
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El-Mallawany NK, Mutai M, Mtete I, Gopal S, Stanley CC, Wasswa P, Mtunda M, Chasela M, Kamiyango W, Villiera J, Fedoriw Y, Montgomery ND, Liomba GN, Kampani C, Krysiak R, Westmoreland KD, Kim MH, Slone JS, Scheurer ME, Allen CE, Mehta PS, Kazembe PN. Beyond Endemic Burkitt Lymphoma: Navigating Challenges of Differentiating Childhood Lymphoma Diagnoses Amid Limitations in Pathology Resources in Lilongwe, Malawi. Glob Pediatr Health 2017; 4:2333794X17715831. [PMID: 28680947 PMCID: PMC5484428 DOI: 10.1177/2333794x17715831] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 05/14/2017] [Indexed: 12/25/2022] Open
Abstract
Background. Although Burkitt lymphoma (BL) is the most common childhood lymphoma in sub-Saharan Africa, Hodgkin lymphoma (HL) and other non-Hodgkin lymphomas occur. Diagnosing non-jaw mass presentations is challenging with limited pathology resources. Procedure. We retrospectively analyzed 114 pediatric lymphomas in Lilongwe, Malawi, from December 2011 to June 2013 and compared clinical versus pathology-based diagnoses over two time periods. Access to pathology resources became more consistent in 2013 compared with 2011-2012; pathology interpretations were based on morphology only. Results. Median age was 8.4 years (2.1-16.3). The most common anatomical sites of presentation were palpable abdominal mass 51%, peripheral lymphadenopathy 35%, and jaw mass 34%. There were 51% jaw masses among clinical diagnoses versus 11% in the pathology-based group (P < .01), whereas 62% of pathology diagnoses involved peripheral lymphadenopathy versus 16% in the clinical group (P < .01). The breakdown of clinical diagnoses included BL 85%, lymphoblastic lymphoma (LBL) 9%, HL 4%, and diffuse large B-cell lymphoma (DLBCL) 1%, whereas pathology-based diagnoses included HL 38%, BL 36%, LBL 15%, and DLBCL 11% (P < .01). Lymphoma diagnosis was pathology confirmed in 19/66 patients (29%) in 2011-2012 and 28/48 (60%) in 2013 (P < .01). The percentage of non-BL diagnoses was consistent across time periods (35%); however, 14/23 (61%) non-BL diagnoses were pathology confirmed in 2011-2012 versus 16/17 (94%) in 2013. Conclusions. Lymphomas other than Burkitt accounted for 35% of childhood lymphoma diagnoses. Over-reliance on clinical diagnosis for BL was a limitation, but confidence in non-BL diagnoses improved with time as pathology confirmation became standard. Increased awareness of non-BL lymphomas in equatorial Africa is warranted.
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Affiliation(s)
- Nader Kim El-Mallawany
- Baylor College of Medicine, Houston, TX, USA.,Texas Children's Cancer and Hematology Centers, Houston, TX, USA
| | - Mercy Mutai
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.,Kamuzu Central Hospital, Lilongwe, Malawi
| | - Idah Mtete
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.,Kamuzu Central Hospital, Lilongwe, Malawi
| | - Satish Gopal
- UNC Project-Malawi, Lilongwe, Malawi.,University of North Carolina, Chapel Hill, NC, USA
| | | | - Peter Wasswa
- Texas Children's Cancer and Hematology Centers, Houston, TX, USA.,Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.,Kamuzu Central Hospital, Lilongwe, Malawi
| | - Mary Mtunda
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.,Kamuzu Central Hospital, Lilongwe, Malawi
| | - Mary Chasela
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.,Kamuzu Central Hospital, Lilongwe, Malawi
| | - William Kamiyango
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.,Kamuzu Central Hospital, Lilongwe, Malawi
| | - Jimmy Villiera
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.,Kamuzu Central Hospital, Lilongwe, Malawi
| | - Yuri Fedoriw
- University of North Carolina, Chapel Hill, NC, USA
| | | | | | | | | | | | - Maria H Kim
- Baylor College of Medicine, Houston, TX, USA.,Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Jeremy S Slone
- Baylor College of Medicine, Houston, TX, USA.,Texas Children's Cancer and Hematology Centers, Houston, TX, USA
| | - Michael E Scheurer
- Baylor College of Medicine, Houston, TX, USA.,Texas Children's Cancer and Hematology Centers, Houston, TX, USA
| | - Carl E Allen
- Baylor College of Medicine, Houston, TX, USA.,Texas Children's Cancer and Hematology Centers, Houston, TX, USA
| | - Parth S Mehta
- Baylor College of Medicine, Houston, TX, USA.,Texas Children's Cancer and Hematology Centers, Houston, TX, USA
| | - Peter N Kazembe
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
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23
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Westmoreland KD, Montgomery ND, Stanley CC, El-Mallawany NK, Wasswa P, van der Gronde T, Mtete I, Butia M, Itimu S, Chasela M, Mtunda M, Kampani C, Liomba NG, Tomoka T, Dhungel BM, Sanders MK, Krysiak R, Kazembe P, Dittmer DP, Fedoriw Y, Gopal S. Plasma Epstein-Barr virus DNA for pediatric Burkitt lymphoma diagnosis, prognosis and response assessment in Malawi. Int J Cancer 2017; 140:2509-2516. [PMID: 28268254 PMCID: PMC5386821 DOI: 10.1002/ijc.30682] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 02/20/2017] [Indexed: 12/26/2022]
Abstract
Point-of-care tools are needed in sub-Saharan Africa (SSA) to improve pediatric Burkitt lymphoma (BL) diagnosis and treatment. We evaluated plasma Epstein-Barr virus (pEBV) DNA as a pediatric BL biomarker in Malawi. Prospectively enrolled children with BL were compared to classical Hodgkin lymphoma (cHL) and nonlymphoma diagnoses. Pediatric BL patients received standardized chemotherapy and supportive care. pEBV DNA was measured at baseline, mid-treatment, and treatment completion. Of 121 assessed children, pEBV DNA was detected in 76/88 (86%) with BL, 16/17 (94%) with cHL, and 2/16 (12%) with nonlymphoma, with proportions higher in BL versus nonlymphoma (p < 0.001) and similar in BL versus cHL (p = 0.69). If detected, median pEBV DNA was 6.1 log10 copies/mL for BL, 4.8 log10 copies/mL for cHL, and 3.4 log10 copies/mL for nonlymphoma, with higher levels in BL versus cHL (p = 0.029), and a trend toward higher levels in BL versus nonlymphoma (p = 0.062). pEBV DNA declined during treatment in the cohort overall and increased in several children before clinical relapse. Twelve-month overall survival was 40% in the cohort overall, and for children with baseline pEBV detected, survival was worse if baseline pEBV DNA was ≥6 log10 copies/mL versus <6 log10 copies/mL (p = 0.0002), and also if pEBV DNA was persistently detectable at mid-treatment versus undetectable (p = 0.041). Among children with baseline pEBV DNA detected, viremia was the only significant risk factor for death by 12 months in multivariate analyses (adjusted hazard ratio 1.35 per log10 copies/mL, 95% CI 1.04-1.75, p = 0.023). Quantitative pEBV DNA has potential utility for diagnosis, prognosis, and response assessment for pediatric BL in SSA.
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Affiliation(s)
| | | | | | | | | | | | - Idah Mtete
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
| | - Mercy Butia
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
| | | | - Mary Chasela
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
| | - Mary Mtunda
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
| | | | | | - Tamiwe Tomoka
- UNC Project-Malawi, Lilongwe, Malawi
- University of Malawi College of Medicine, Blantyre, Malawi
| | | | | | | | - Peter Kazembe
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
| | | | | | - Satish Gopal
- UNC Project-Malawi, Lilongwe, Malawi
- University of North Carolina, Chapel Hill, USA
- University of Malawi College of Medicine, Blantyre, Malawi
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24
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Dozzo M, Carobolante F, Donisi PM, Scattolin A, Maino E, Sancetta R, Viero P, Bassan R. Burkitt lymphoma in adolescents and young adults: management challenges. Adolesc Health Med Ther 2017; 8:11-29. [PMID: 28096698 PMCID: PMC5207020 DOI: 10.2147/ahmt.s94170] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
About one-half of all Burkitt lymphoma (BL) patients are younger than 40 years, and one-third belong to the adolescent and young adult (AYA) subset, defined by an age between 15 and 25-40 years, based on selection criteria used in different reports. BL is an aggressive B-cell neoplasm displaying highly characteristic clinico-diagnostic features, the biologic hallmark of which is a translocation involving immunoglobulin and c-MYC genes. It presents as sporadic, endemic, or epidemic disease. Endemicity is pathogenetically linked to an imbalance of the immune system which occurs in African children infected by malaria parasites and Epstein-Barr virus, while the epidemic form strictly follows the pattern of infection by HIV. BL shows propensity to extranodal involvement of abdominal organs, bone marrow, and central nervous system, and can cause severe metabolic and renal impairment. Nevertheless, BL is highly responsive to specifically designed short-intensive, rotational multiagent chemotherapy programs, empowered by the anti-CD20 monoclonal antibody rituximab. When carefully applied with appropriate supportive measures, these modern programs achieve a cure rate of approximately 90% in the average AYA patient, irrespective of clinical stage, which is the best result achievable in any aggressive lymphoid malignancy to date. The challenges ahead concern the following: optimization of management in underdeveloped countries, with reduction of diagnostic and referral-for-care intervals, and the applicability of currently curative regimens; the development of lower intensity but equally effective treatments for frail or immunocompromised patients at risk of death by complications; the identification of very high-risk patients through positron-emission tomography and minimal residual disease assays; and the assessment in these and the few refractory/relapsed ones of new monoclonals (ofatumumab, blinatumomab, inotuzumab ozogamicin) and new molecules targeting c-MYC and key proliferative steps of B-cell malignancies.
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Affiliation(s)
- Massimo Dozzo
- Complex Operative Unit of Hematology, Ospedale dell’Angelo
| | | | - Pietro Maria Donisi
- Simple Departmental Operative Unit of Anatomic Pathology, Ospedale Ss. Giovanni e Paolo, Venice, Italy
| | | | - Elena Maino
- Complex Operative Unit of Hematology, Ospedale dell’Angelo
| | | | - Piera Viero
- Complex Operative Unit of Hematology, Ospedale dell’Angelo
| | - Renato Bassan
- Complex Operative Unit of Hematology, Ospedale dell’Angelo
- Correspondence: Renato Bassan, Complex Operative Unit of Hematology, Ospedale dell’Angelo, Via Paccagnella 11, 30174 Mestre-Venice, Italy, Tel +39 41 965 7362, Fax +39 41 965 7361, Email
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25
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Buckle G, Maranda L, Skiles J, Ong'echa JM, Foley J, Epstein M, Vik TA, Schroeder A, Lemberger J, Rosmarin A, Remick SC, Bailey JA, Vulule J, Otieno JA, Moormann AM. Factors influencing survival among Kenyan children diagnosed with endemic Burkitt lymphoma between 2003 and 2011: A historical cohort study. Int J Cancer 2016; 139:1231-40. [PMID: 27136063 PMCID: PMC5489240 DOI: 10.1002/ijc.30170] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 04/19/2016] [Indexed: 12/23/2022]
Abstract
Discovering how to improve survival and establishing clinical reference points for children diagnosed with endemic Burkitt lymphoma (eBL) in resource-constrained settings has recaptured international attention. Using multivariate analyses, we evaluated 428 children with eBL in Kenya for age, gender, tumor stage, nutritional status, hemoglobin, lactate dehydrogenase (LDH), Epstein-Barr virus (EBV) and Plasmodium falciparum prior to induction of chemotherapy (cyclophosphamide, vincristine, methotrexate and doxorubicin) to identify predictive and prognostic biomarkers of survival. During this 10 year prospective study period, 22% died in-hospital and 78% completed six-courses of chemotherapy. Of those, 16% relapsed or died later; 31% achieved event-free-survival; and 31% were lost to follow-up; the overall one-year survival was 45%. After adjusting for covariates, low hemoglobin (<8 g/dL) and high LDH (>400 mU/ml) were associated with increased risk of death (adjusted Hazard Ratio (aHR) = 1.57 [0.97-2.41]) and aHR = 1.84, [0.91-3.69], respectively). Anemic children with malaria were 3.55 times more likely to die [1.10-11.44] compared to patients without anemia or malarial infection. EBV load did not differ by tumor stage nor was it associated with survival. System-level factors can also contribute to poor outcomes. Children were more likely to die when inadvertently overdosed by more than 115% of the correct dose of cyclophosphamide (a HR = 1.43 [0.84-2.43]) or doxorubicin (a HR = 1.25, [0.66-2.35]), compared with those receiving accurate doses of the respective agent in this setting. This study codifies risk factors associated with poor outcomes for eBL patients in Africa and provides a benchmark by which to assess improvements in survival for new chemotherapeutic approaches.
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Affiliation(s)
- Geoffrey Buckle
- Molecular Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655
| | - Louise Maranda
- Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Avenue North, ASC6.1063, Worcester, MA 01655
| | - Jodi Skiles
- Pediatrics, Hemotology/Oncology, Indiana University School of Medicine, Full address: 705 Riley Hospital Drive, RI 2629, Indianapolis, IN 46202
| | - John Michael Ong'echa
- Center for Global, Health Research Kenya Medical Research Institute, P. O. Box 1578-40100, Kisumu, Kenya
| | - Joslyn Foley
- Molecular Medicine, University of Massachusetts Medical School, 373 Plantation St. Biotech 2, Suite 318, Worcester, MA 01605
| | - Mara Epstein
- Quantitative Health Sciences, University of Massachusetts Medical School, 365 Plantation St. Biotech 1, Suite 100, Worcester, MA 01605
| | - Terry A. Vik
- Pediatrics, Hemotology/Oncology, Indiana University School of Medicine, Full address: 705 Riley Hospital Drive, ROC 4340, Indianapolis, IN 46202
| | | | | | - Alan Rosmarin
- Medicine, Hematology/Oncology, University of Massachusetts Medical School, 55 Lake Avenue North, H8-533, Worcester, MA 01655
| | - Scot C. Remick
- Physician Leader, Oncology and Senior Scientist, Maine Medical Center and Maine Medical Center Research Institute, Portland, ME 04074
| | - Jeffrey A. Bailey
- Medicine, Bioinformatics, University of Massachusetts Medical School, 55 Lake Avenue North, ASC4.1077, Worcester, MA 01655
| | - John Vulule
- Center for Global Health Research, Kenya Medical Research Institute, P. O. Box 1578-40100, Kisumu, Kenya
| | - Juliana A. Otieno
- Jaramogi Oginga Odinga Teaching and Referral Hospital, Kenya Ministry of Health, P.O. Box 849-40100, Kisumu, Kenya
| | - Ann M. Moormann
- Molecular Medicine, University of Massachusetts Medical School, 373 Plantation Street, Biotech 2, Suite 318, Worcester MA, 01605 USA
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26
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Sissolak G, Seftel M, Uldrick TS, Esterhuizen TM, Mohamed N, Kotze D. Burkitt's Lymphoma and B-Cell Lymphoma Unclassifiable With Features Intermediate Between Diffuse Large B-Cell Lymphoma and Burkitt's Lymphoma in Patients With HIV: Outcomes in a South African Public Hospital. J Glob Oncol 2016; 3:218-226. [PMID: 28717763 PMCID: PMC5493215 DOI: 10.1200/jgo.2015.002378] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose Burkitt’s lymphoma (BL) is a common HIV-associated lymphoma in South Africa. B-cell lymphoma unclassifiable with features intermediate between diffuse large B-cell lymphoma and Burkitt’s lymphoma (BL/DLBCL) also occurs in HIV infection. Outcomes of HIV-infected patients with BL or BL/DLBCL in a resource-constrained setting are not defined. Methods We performed a retrospective study of HIV-positive patients with BL or BL/DLBCL treated from 2004 to 2012 with curative intent at a publically funded academic medical center in South Africa. Differences between BL and BL/DLBCL, survival outcomes, and factors associated with survival were analyzed. Results There were 35 patients with either HIV-associated BL (24) or BL/DLBCL (11) who met study criteria. Median CD4+ T-lymphocyte count at lymphoma diagnosis was 188 cells/μL (range, 10 to 535 cells/μL). Patients with BL/DLBCL were significantly older and had less bone marrow involvement and lower baseline serum lactase dehydrogenase than patients with BL. Eighty-nine percent of patients presented with advanced disease, and 25% had baseline CNS involvement. Chemotherapy regimens consisted of cytoreduction with low-dose cyclophosphamide, vincristine, and prednisone followed by induction with vincristine, methotrexate, cyclophosphamide, doxorubicin and prednisone (LMB 86; 57%); hyperfractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone, methotrexate, and cytarabine (hyper-CVAD; 20%); cyclophosphamide, doxorubicin, vincristine, and prednisone and high-dose methotrexate with leucovorin rescue on day 10 with accompanying prophylactic IT chemotherapy (Stanford regimen; 14%); and cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP-like; 9%) regimens. Twenty-three patients received CNS treatment or prophylaxis, and 31 received concurrent combination antiretroviral therapy. Two-year overall survival was 38% (95% CI, 22% to 54%) and 2-year event-free survival was 23% (95% CI, 11% to 38%), with no difference between histologic subtypes. Common causes of death were infection (41%) and CNS disease progression or systemic relapse (41%). Conclusion Cure of HIV-associated BL and BL/DLBCL with intensive regimens is possible in resource-limited settings, but lower toxicity regimens, improved CNS prophylaxis, and increased resources for supportive care are required.
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Affiliation(s)
- Gerhard Sissolak
- , , , and , Tygerberg Academic Hospital and Stellenbosch University, Cape Town, South Africa; , University of Manitoba, Winnipeg, Manitoba, Canada; and , National Cancer Institute, Bethesda, MD
| | - Matthew Seftel
- , , , and , Tygerberg Academic Hospital and Stellenbosch University, Cape Town, South Africa; , University of Manitoba, Winnipeg, Manitoba, Canada; and , National Cancer Institute, Bethesda, MD
| | - Thomas S Uldrick
- , , , and , Tygerberg Academic Hospital and Stellenbosch University, Cape Town, South Africa; , University of Manitoba, Winnipeg, Manitoba, Canada; and , National Cancer Institute, Bethesda, MD
| | - Tonya M Esterhuizen
- , , , and , Tygerberg Academic Hospital and Stellenbosch University, Cape Town, South Africa; , University of Manitoba, Winnipeg, Manitoba, Canada; and , National Cancer Institute, Bethesda, MD
| | - Nooroudien Mohamed
- , , , and , Tygerberg Academic Hospital and Stellenbosch University, Cape Town, South Africa; , University of Manitoba, Winnipeg, Manitoba, Canada; and , National Cancer Institute, Bethesda, MD
| | - Danie Kotze
- , , , and , Tygerberg Academic Hospital and Stellenbosch University, Cape Town, South Africa; , University of Manitoba, Winnipeg, Manitoba, Canada; and , National Cancer Institute, Bethesda, MD
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27
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Cairo MS, Pinkerton R. Childhood, adolescent and young adult non-Hodgkin lymphoma: state of the science. Br J Haematol 2016; 173:507-30. [DOI: 10.1111/bjh.14035] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Mitchell S. Cairo
- Department of Pediatrics, Medicine, Pathology, Microbiology & Immunology and Cell Biology & Anatomy; New York Medical College; Valhalla NY USA
| | - Ross Pinkerton
- Department of Oncology; Children's Health Queensland; Brisbane Australia
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28
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Stanley CC, Westmoreland KD, Heimlich BJ, El-Mallawany NK, Wasswa P, Mtete I, Butia M, Itimu S, Chasela M, Mtunda M, Chikasema M, Makwakwa V, Kaimila B, Kasonkanji E, Chimzimu F, Kampani C, Dhungel BM, Krysiak R, Montgomery ND, Fedoriw Y, Rosenberg NE, Liomba NG, Gopal S. Outcomes for paediatric Burkitt lymphoma treated with anthracycline-based therapy in Malawi. Br J Haematol 2016; 173:705-12. [PMID: 26914979 DOI: 10.1111/bjh.13986] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 12/21/2015] [Indexed: 10/22/2022]
Abstract
Burkitt lymphoma (BL) is the most common paediatric cancer in sub-Saharan Africa (SSA). Anthracyline-based treatment is standard in resource-rich settings, but has not been described in SSA. Children ≤18 years of age with newly diagnosed BL were prospectively enrolled from June 2013 to May 2015 in Malawi. Staging and supportive care were standardized, as was treatment with CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) for six cycles. Among 73 children with BL, median age was 9·2 years (interquartile range 7·7-11·8), 48 (66%) were male and two were positive for human immunodeficiency virus. Twelve (16%) had stage I/II disease, 36 (49%) stage III and 25 (34%) stage IV. Grade 3/4 neutropenia occurred in 17 (25%), and grade 3/4 anaemia in 29 (42%) of 69 evaluable children. Eighteen-month overall survival was 29% (95% confidence interval [CI] 18-41%) overall. Mortality was associated with age >9 years [hazard ratio [HR] 2·13, 95% CI 1·15-3·94], female gender (HR 2·12, 95% CI 1·12-4·03), stage (HR 1·52 per unit, 95% CI 1·07-2·17), lactate dehydrogenase (HR 1·03 per 100 iu/l, 95% CI 1·01-1·05), albumin (HR 0·96 per g/l, 95% CI 0·93-0·99) and performance status (HR 0·78 per 10-point increase, 95% CI 0·69-0·89). CHOP did not improve outcomes in paediatric BL compared to less intensive regimens in Malawi.
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Affiliation(s)
| | | | | | | | | | - Idah Mtete
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Mercy Butia
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | | | - Mary Chasela
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Mary Mtunda
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | | | | | | | | | | | | | | | | | | | - Yuri Fedoriw
- University of North Carolina, Chapel Hill, North Carolina
| | - Nora E Rosenberg
- UNC Project-Malawi, Lilongwe, Malawi.,University of North Carolina, Chapel Hill, North Carolina
| | | | - Satish Gopal
- UNC Project-Malawi, Lilongwe, Malawi.,University of North Carolina, Chapel Hill, North Carolina.,University of Malawi College of Medicine, Blantyre, Malawi
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29
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Depani S, Banda K, Bailey S, Israels T, Chagaluka G, Molyneux E. Outcome is unchanged by adding vincristine upfront to the Malawi 28-day protocol for endemic Burkitt lymphoma. Pediatr Blood Cancer 2015; 62:1929-34. [PMID: 26052841 DOI: 10.1002/pbc.25612] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 05/05/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND We previously reported a 28-day treatment protocol for children with endemic Burkitt lymphoma (BL) which included four doses of cyclophosphamide (CPM), intrathecal methotrexate and hydrocortisone (IT MTX/HC) at Queen Elizabeth Central Hospital (QECH) in Malawi which resulted in an Event-Free Survival (EFS) of 50% at 1 year. METHODS In an attempt to improve survival whilst maintaining acceptable toxicity, brevity, low-cost and a standard treatment for all patients, four doses of vincristine (VCR) at 1.5 mg/m(2) were added to the backbone of CPM 40 mg/kg on day 1 and 60 mg/kg on days 8,18 and 28 and IT MTX /HC 12.5 mg on days 1,8,18 and 28. RESULTS Seventy cytology confirmed cases of BL, 42 males and 28 females with a median age of 80 years, were treated with this protocol between January 2010 and April 2012. Four percent had St Jude Stage I disease; 29% Stage II; 30% Stage III and 37% Stage IV. Disease site in order of frequency was face (64%); abdomen (47%); CSF (26%) and paraspinal (17%). There were two on-treatment deaths. Sixty-three percent required antibiotics and 19% required blood transfusion. Eighty-one percent of patients achieved complete clinical remission at day 28. Overall predicted EFS at 1 year was 48%; 100% in Stage I, 83% in Stage II, 24% in Stage III and 32% in Stage IV disease. EFS was significantly worse in patients with Stage III/IV disease (P = 0.002) and paraplegia (P = 0.002). CONCLUSION The addition of vincristine to the Malawi 28 day BL treatment protocol did not improve survival.
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Affiliation(s)
- Sarita Depani
- Department of Paediatric, Queen Elizabeth Central Hospital, Blantyre, Malawi.,Children and Young People's Cancer Service, University College Hospital, London, UK
| | - Kondwani Banda
- Department of Paediatric, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Simon Bailey
- Department of Paediatric Oncology, Great North Childrens Hospital, Newcastle, UK
| | - Trijn Israels
- Department of Paediatric Oncology, Outreach Programme, VU University Medical Centre, Amsterdam, the Netherlands
| | - George Chagaluka
- Department of Paediatric, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Elizabeth Molyneux
- Department of Paediatric, Queen Elizabeth Central Hospital, Blantyre, Malawi
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Kingham TP, Alatise OI. Establishing Translational and Clinical Cancer Research Collaborations Between High- and Low-Income Countries. Ann Surg Oncol 2015; 22:741-6. [DOI: 10.1245/s10434-014-4342-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Indexed: 11/18/2022]
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Rowe M, Fitzsimmons L, Bell AI. Epstein-Barr virus and Burkitt lymphoma. CHINESE JOURNAL OF CANCER 2014; 33:609-19. [PMID: 25418195 PMCID: PMC4308657 DOI: 10.5732/cjc.014.10190] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 11/06/2014] [Indexed: 12/12/2022]
Abstract
In 1964, a new herpesvirus, Epstein-Barr virus (EBV), was discovered in cultured tumor cells derived from a Burkitt lymphoma (BL) biopsy taken from an African patient. This was a momentous event that reinvigorated research into viruses as a possible cause of human cancers. Subsequent studies demonstrated that EBV was a potent growth-transforming agent for primary B cells, and that all cases of BL carried characteristic chromosomal translocations resulting in constitutive activation of the c-MYC oncogene. These results hinted at simple oncogenic mechanisms that would make Burkitt lymphoma paradigmatic for cancers with viral etiology. In reality, the pathogenesis of this tumor is rather complicated with regard to both the contribution of the virus and the involvement of cellular oncogenes. Here, we review the current understanding of the roles of EBV and c-MYC in the pathogenesis of BL and the implications for new therapeutic strategies to treat this lymphoma.
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Affiliation(s)
- Martin Rowe
- School of Cancer Sciences, University of Bir-mingham CMDS, Vincent Drive, Edgbaston, Birmingham, B15 2TT, UK.
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Kruger M, Hendricks M, Davidson A, Stefan CD, van Eyssen AL, Uys R, van Zyl A, Hesseling P. Childhood cancer in Africa. Pediatr Blood Cancer 2014; 61:587-92. [PMID: 24214130 DOI: 10.1002/pbc.24845] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 10/09/2013] [Indexed: 12/11/2022]
Abstract
The majority of children with cancer live in low- and middle-income countries (LMICs) with little or no access to cancer treatment. The purpose of the paper is to describe the current status of childhood cancer treatment in Africa, as documented in publications, dedicated websites and information collected through surveys. Successful twinning programmes, like those in Malawi and Cameroon, as well as the collaborative clinical trial approach of the Franco-African Childhood Cancer Group (GFAOP), provide good models for childhood cancer treatment. The overview will hopefully influence health-care policies to facilitate access to cancer care for all children in Africa.
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Affiliation(s)
- Mariana Kruger
- Department of Paediatrics and Child Health, Tygerberg Hospital, University of Stellenbosch, Cape Town, South Africa
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Magrath I, Epelman S. Cancer in Adolescents and Young Adults in Countries with Limited Resources. Curr Oncol Rep 2013; 15:332-46. [DOI: 10.1007/s11912-013-0327-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Magrath I, Steliarova-Foucher E, Epelman S, Ribeiro RC, Harif M, Li CK, Kebudi R, Macfarlane SD, Howard SC. Paediatric cancer in low-income and middle-income countries. Lancet Oncol 2013; 14:e104-16. [PMID: 23434340 DOI: 10.1016/s1470-2045(13)70008-1] [Citation(s) in RCA: 252] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Patterns of cancer incidence across the world have undergone substantial changes as a result of industrialisation and economic development. However, the economies of most countries remain at an early or intermediate stage of development-these stages are characterised by poverty, too few health-care providers, weak health systems, and poor access to education, modern technology, and health care because of scattered rural populations. Low-income and middle-income countries also have younger populations and therefore a larger proportion of children with cancer than high-income countries. Most of these children die from the disease. Chronic infections, which remain the most common causes of disease-related death in all except high-income countries, can also be major risk factors for childhood cancer in poorer regions. We discuss childhood cancer in relation to global development and propose strategies that could result in improved survival. Education of the public, more and better-trained health professionals, strengthened cancer services, locally relevant research, regional hospital networks, international collaboration, and health insurance are all essential components of an enhanced model of care.
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Affiliation(s)
- Ian Magrath
- International Network for Cancer Treatment and Research, Brussels, Belgium.
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