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Ekpa QL, Akahara PC, Anderson AM, Adekoya OO, Ajayi OO, Alabi PO, Okobi OE, Jaiyeola O, Ekanem MS. A Review of Acute Lymphocytic Leukemia (ALL) in the Pediatric Population: Evaluating Current Trends and Changes in Guidelines in the Past Decade. Cureus 2023; 15:e49930. [PMID: 38179374 PMCID: PMC10766210 DOI: 10.7759/cureus.49930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 01/06/2024] Open
Abstract
Acute lymphocytic leukemia (ALL) is a commonly diagnosed cancer in children. Despite technological advancements to improve treatment and survival rates, there has been a steady increase in the incidence of ALL and treatment failures. This paper discusses the pathogenic interaction between genetic and environmental factors leading to childhood ALL. It evaluates the current treatment guidelines and notable obstacles leading to resistance, relapse, and treatment toxicities. The review evaluates a 10-year trend in the management guidelines of pediatric ALL through a systematic literature review of records from 2012 to 2023. Findings show that improvement in the five-year survival rates, notwithstanding rates of relapse and incurable diseases, is still high. Furthermore, several risk factors, including an interplay between genetic and environmental factors, are largely contributory to the outcome of ALL treatments and its overall incidence. Moreover, huge financial costs have remained a significant challenge in outcomes. There remains a need to provide individualized treatment plans, shared decision-making, and goals of care as parts of the management guidelines for the best possible outcomes. We expect that future advancements will increase overall survival rates and disease-free years.
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Affiliation(s)
- Queen L Ekpa
- General Practice, Conestoga College, Kitchener, CAN
| | | | - Alexis M Anderson
- Pediatric Medicine, St. George's University, School of Medicine, St. George's, GRD
| | | | - Olamide O Ajayi
- Pediatrics, Medway Maritime Hospital, Kent, GBR
- Internal Medicine, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Sagamu, NGA
| | - Peace O Alabi
- Pediatrics, University of Abuja Teaching Hospital, Abuja, NGA
| | - Okelue E Okobi
- Family Medicine, Larkin Community Hospital Palm Springs Campus, Hialeah, USA
- Family Medicine, Medficient Health Systems, Laurel, USA
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
| | | | - Medara S Ekanem
- General Medicine, Babcock University Teaching Hospital, Ilishan-Remo, NGA
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Gallardo-Pérez MM, Gale RP, Reyes-Cisneros OA, Sánchez-Bonilla D, Fernández-Gutiérrez JA, Stock W, Murrieta-Álvarez I, Olivares-Gazca JC, Ruiz-Delgado GJ, Fonseca R, Ruiz-Argüelles GJ. Therapy of childhood acute lymphoblastic leukemia in resource-poor geospaces. Front Oncol 2023; 13:1187268. [PMID: 37397374 PMCID: PMC10312136 DOI: 10.3389/fonc.2023.1187268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/05/2023] [Indexed: 07/04/2023] Open
Abstract
The therapy of children with acute lymphoblastic leukemia (ALL) in limited resource geospaces is challenging and must balance safety, efficacy, availability, and affordability. We modified the control arm of the St. Jude Total XI protocol for outpatient delivery including once-weekly daunorubicin and vincristine in initial therapy, postponing intrathecal chemotherapy until day 22, prophylactic oral antibiotics/antimycotics, use of generic drugs, and no central nervous system (CNS) radiation. Data were interrogated from 104 consecutive children ≤12 years (median, 6 years [interquartile range (IQR), 3, 9 years]. All therapies were given in an outpatient setting in 72 children. Median follow-up is 56 months (IQR 20, 126 months). A total of 88 children achieved a hematological complete remission. Median event-free survival (EFS) is 87 months [95% confidence interval (CI), 39, 60], 7.6 years in low-risk children (3.4, 8 years) whereas 2.5 years (1, 10 years) in high-risk children. The 5-year cumulative incidence of relapse (CIR) is 28% (18, 35%), 26% (14, 37%) in low-risk children and 35% (14, 52%) in high-risk children. Median survival for all subjects is not reached but must exceed 5 years. A total of 36 children relapsed at a median of 12 months (5, 23 months). Outcomes were comparable to those reported in the control arm of the Total Therapy XI study, but inferior to current treatment protocols in high-income countries. The average cost of the first 2 years of therapy was $28,500 USD compared with an average cost of approximately $150,000 USD in the US, an 80% saving. In conclusion, using an outpatient-based modification of the St. Jude Total XI protocol, we obtained good results with relatively few hospitalizations or adverse events and at a substantial saving. This model can be applied in other resource-poor geospaces.
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Affiliation(s)
- Moisés M. Gallardo-Pérez
- Centro de Hematología y Medicina Interna, Clínica Ruiz, Puebla, Puebla, Mexico
- Universidad Popular Autónoma del Estado de Puebla, Facultad de Medicina, Puebla, Puebla, Mexico
| | - Robert Peter Gale
- Centre for Haematology, Imperial College of Science, Technology and Medicine, London, United Kingdom
| | - Oscar A. Reyes-Cisneros
- Centro de Hematología y Medicina Interna, Clínica Ruiz, Puebla, Puebla, Mexico
- Universidad Anáhuac, Facultad de Medicina, Puebla, Puebla, Mexico
| | - Daniela Sánchez-Bonilla
- Centro de Hematología y Medicina Interna, Clínica Ruiz, Puebla, Puebla, Mexico
- Universidad Popular Autónoma del Estado de Puebla, Facultad de Medicina, Puebla, Puebla, Mexico
| | - José A. Fernández-Gutiérrez
- Centro de Hematología y Medicina Interna, Clínica Ruiz, Puebla, Puebla, Mexico
- Universidad Popular Autónoma del Estado de Puebla, Facultad de Medicina, Puebla, Puebla, Mexico
| | - Wendy Stock
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Iván Murrieta-Álvarez
- Centro de Hematología y Medicina Interna, Clínica Ruiz, Puebla, Puebla, Mexico
- Universidad Popular Autónoma del Estado de Puebla, Facultad de Medicina, Puebla, Puebla, Mexico
| | - Juan Carlos Olivares-Gazca
- Centro de Hematología y Medicina Interna, Clínica Ruiz, Puebla, Puebla, Mexico
- Universidad Popular Autónoma del Estado de Puebla, Facultad de Medicina, Puebla, Puebla, Mexico
| | - Guillermo J. Ruiz-Delgado
- Centro de Hematología y Medicina Interna, Clínica Ruiz, Puebla, Puebla, Mexico
- Universidad Popular Autónoma del Estado de Puebla, Facultad de Medicina, Puebla, Puebla, Mexico
- Laboratorios Ruiz, SYNLAB, Puebla, Puebla, Mexico
| | - Rafael Fonseca
- Mayo Clinic, Division of Hematology-Oncology, Scottsdale, AZ, United States
| | - Guillermo J. Ruiz-Argüelles
- Centro de Hematología y Medicina Interna, Clínica Ruiz, Puebla, Puebla, Mexico
- Universidad Popular Autónoma del Estado de Puebla, Facultad de Medicina, Puebla, Puebla, Mexico
- Laboratorios Ruiz, SYNLAB, Puebla, Puebla, Mexico
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3
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Mofidi A, Khan Kermanshahi SM, Jaseb K. Effect of a partnership care programme on quality of life in school-age children with leukaemia: a controlled clinical trial. Int J Palliat Nurs 2023; 29:66-74. [PMID: 36822617 DOI: 10.12968/ijpn.2023.29.2.66] [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: 02/25/2023]
Abstract
Background: Despite the low quality of life (QoL) of children with leukaemia, there is a lack of well-designed and culture-oriented care programmes to improve it. The Partnership Care Model (PCM), which was developed based on the Iranian culture, seems to be effective in improving the QoL in children living with chronic diseases. Aim: This study aimed to evaluate the effect of a care programme based on the PCM on the QoL of children with leukaemia. Methods: This controlled clinical trial encompassed 60 school-age children with leukaemia and their mothers. In the experimental group (n=30), a 2-month care programme was implemented based on the PCM, including the four stages of motivation, preparation, involvement and evaluation. Only standard care was provided to the control group (n=30). Children's QoL was assessed using the Paediatric Quality of Life Inventory 3.0 Cancer Module in the pre-test phase and 2 months after the intervention. Findings: The total score of QoL and all its subscales were significantly higher in the experimental group than the control group in the post-test phase (p<0.001). Moreover, a significant difference was observed between pre-test and post-test scores in all domains in the experimental group (p<0.001); however, no significant difference was noticed between the scores in the control group. Conclusion: The partnership care programme seems to improve the QoL in children with leukaemia. Future investigations are recommended to shed further light on the findings of this study.
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Affiliation(s)
- Afsaneh Mofidi
- MSc Student of Nursing, Department of Nursing, Tarbiat Modares University, Iran
| | | | - Kaveh Jaseb
- Assistant Professor, Department of Pediatric Hematology and Oncology, Ahvaz Jundishapur University of Medical Sciences, Iran
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Olbara G, van der Wijk T, Njuguna F, Langat S, Mwangi H, Skiles J, Vik TA, Kaspers GJL, Mostert S. Childhood acute lymphoblastic leukemia treatment in an academic hospital in Kenya: Treatment outcomes and health-care providers' perspectives. Pediatr Blood Cancer 2021; 68:e29366. [PMID: 34569156 DOI: 10.1002/pbc.29366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 08/24/2021] [Accepted: 08/30/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Early deaths and treatment nonadherence are major reasons for low childhood acute lymphoblastic leukemia (ALL) survival in low- and middle-income countries. This study assessed treatment outcomes of children presenting with ALL and evaluated perspectives of health-care providers (HCP) on ALL treatment at a Kenyan academic hospital. METHODS This was a combined retrospective medical records and cross-sectional questionnaire study. Treatment outcomes of 136 children diagnosed with ALL between 2010 and 2016 were collected. Questionnaires were completed by 245 HCP (response rate, 86%) between September and October 2016. RESULTS Childhood ALL treatment outcomes were death (30%), progressive or relapsed disease (26%), abandonment (24%), and event-free survival (20%). Of all deaths, 80% were early deaths (prior or during induction), whereas 20% occurred in remission. Probability of event-free survival at three years was 18%. Only 57% of HCP believed childhood ALL can be cured, with more doctors (96%) than other HCP (45%) believing in curability of ALL (P < 0.001). The majority of HCP (96%) thought that experienced doctors should put more time and effort into making parents understand the diagnosis and necessity to complete treatment. According to HCP, reasons for protocol nonadherence included parental financial difficulties (94%) and use of alternative treatment (79%). CONCLUSIONS Event-free survival for ALL in Kenya is low. The primary reason for treatment failure is early death from treatment-related complications. More efforts should be directed toward improving supportive care strategies. In the opinion of HCPs, improved communication with parents and supervision of junior staff will improve ALL treatment outcomes.
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Affiliation(s)
- Gilbert Olbara
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Thyra van der Wijk
- Emma's Children Hospital, Amsterdam UMC, Vrjie Universiteit, Amsterdam, The Netherlands
| | - Festus Njuguna
- Department of Child Health and Pediatrics, Moi University, School of Medicine, Eldoret, Kenya
| | - Sandra Langat
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Henry Mwangi
- Department of Health Information Management, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Jodi Skiles
- Department of Pediatrics, Division of Hemato-Oncology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Terrry A Vik
- Department of Child Health and Pediatrics, Moi University, School of Medicine, Eldoret, Kenya.,Department of Pediatrics, Division of Hemato-Oncology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Gertjan J L Kaspers
- Emma's Children Hospital, Amsterdam UMC, Vrjie Universiteit, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Saskia Mostert
- Emma's Children Hospital, Amsterdam UMC, Vrjie Universiteit, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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5
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Treatment outcomes for childhood acute lymphoblastic leukemia in low-middle income country before minimal residual disease risk stratification. Cancer Epidemiol 2021; 75:102040. [PMID: 34649157 DOI: 10.1016/j.canep.2021.102040] [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: 04/16/2021] [Revised: 09/09/2021] [Accepted: 09/11/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Outcome of childhood acute lymphoblastic leukemia (ALL) in low- and middle-income countries is lagging in many aspects including diagnosis, risk stratification, access to treatment and supportive care. OBJECTIVE to report the outcome of childhood ALL at Ain Shams University Children's Hospitals with the use of risk-based protocols before the implementation of minimal residual disease technology and to evaluate the use of double delayed intensification (DDI) in standard risk patients. METHODS Two hundred and twenty patients with ALL diagnosed between January 2005 and December 2014 were included in the study. Patients were treated according to a modified CCG 1991 and 1961 for standard and high risk respectively. Patients were stratified into three risk groups: standard risk (SR), high-risk standard arm (HR-SA), and high-risk augmented arm (HR-AA). RESULTS Among the whole cohort, the 10-year event-free survival (EFS) and overall survival (OS) were 78.1% and 84.3% respectively. Patients with Pre-B immunophenotype (IPT) had significantly better outcome than T-cell IPT (EFS 82.0% versus 58.6%, p < 0.001; OS 86.9% versus 69%, p = 0.003 for Pre-B and T-cell respectively). Among the SR group, patients treated with single delayed intensification (SDI) had comparable EFS and OS rates when compared to patients treated with DDI with EFS 82.4% versus 87.5%, p = 0.825 and OS 88.2% versus 93.5%, p = 0.638 for SDI and DDI groups, respectively. CONCLUSION The use of risk-based protocol with simple laboratory techniques resulted in acceptable survival outcome in resource limited settings. The use of double delayed intensification showed no survival advantage in patients with standard risk.
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Sari NM, Rakhmilla LE, Bashari MH, Zazuli Z, Suryawan N, Susanah S, Reniarti L, Raspati H, Supriadi E, Kaspers GJL, Idjradinata P. Monitoring Of High-Dose Methotrexate (Mtx)-Related Toxicity and Mtx Levels in Children with Acute Lymphoblastic Leukemia: A Pilot-Study in Indonesia. Asian Pac J Cancer Prev 2021; 22:2025-2031. [PMID: 34319023 PMCID: PMC8607079 DOI: 10.31557/apjcp.2021.22.7.2025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 07/21/2021] [Indexed: 11/25/2022] Open
Abstract
The administration of high-dose methotrexate (HD-MTX) requires an accurate monitoring of blood MTX levels to determine the regimen of leucovorin rescue and urine alkalinization to prevent toxicity. However, it is technically and logistically challenging to screen patients routinely in limited-resource settings. This study aimed to evaluate blood MTX levels at 24- and 48-hours from start of infusion in relation to clinical toxicity in childhood ALL. METHODS A prospective cohort study was conducted on 32 consecutive children with acute lymphoblastic leukemia (ALL) who had received at least one cycle of 1 g/m2 HD-MTX intravenous infusion as a part of consolidation treatment based on the 2013 Indonesian ALL Protocol. In total, 68 cycles were evaluated. Serum MTX concentrations were measured using enzyme immunoassay. MTX toxicity was categorized using common toxicity criteria (CTCAE) 3.0 version. The association between MTX level and clinical toxicity was assessed by non-parametric analysis. RESULTS The 24-hours MTX level was median 29.8 ng/mL (0.065 µmol/L) (IQR 8.1-390.6) with a modest decrease in 48-hours MTX serum level in all cycles (median 28.3 ng/mL and 0.062 µmol/L; IQR 0.35-28.7; p <0.05). The two most common toxicities were hepatotoxicity (32.2%) and neutropenia (30.9%). Nephrotoxicity and febrile neutropenia occurred in 8.8% and 5.8% of patients, respectively, with low percentage of mucositis (4.3%) and thrombocytopenia (5.6%) recorded. No statistically significant association was found between MTX levels and clinical toxicity, except for liver toxicity. CONCLUSION Serum MTX levels at 24-hours and 48-hours are low, followed by only 4.4% grade III/IV hepatotoxicity and 26,4% grade III/IV neutropenia. There is no significant association between the clinical toxicity and MTX levels at the two points of measurement. An attempt to increase the MTX dose and/or to introduce a loading dose should be considered in subsequent ALL protocol as supported by further pharmacokinetic MTX studies in the Indonesian population.
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Affiliation(s)
- Nur Melani Sari
- Hematology Oncology Division, Department of Child Health Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.
| | - Lulu E. Rakhmilla
- Department of Public Health, Division of Epidemiology and Biostatistics, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia.
| | - Muhammad Hasan Bashari
- Department of Biomedical Sciences, Division of Pharmacology and Therapy, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.
| | - Zulfan Zazuli
- Department of Pharmacology-Clinical Pharmacy, School of Pharmacy, Bandung Institute Technology, Bandung, Indonesia.
- Amsterdam UMC, location Academic Medical Center, Amsterdam, Netherlands.
| | - Nur Suryawan
- Hematology Oncology Division, Department of Child Health Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.
| | - Susi Susanah
- Hematology Oncology Division, Department of Child Health Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.
| | - Lelani Reniarti
- Hematology Oncology Division, Department of Child Health Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.
| | - Harry Raspati
- Hematology Oncology Division, Department of Child Health Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.
| | - Eddy Supriadi
- Pediatric Hematology Oncology Division, Department of Pediatrics, Dr Sardjito Hospital-Faculty of Medicine Public Health and Nursing Universitas, Gajah Mada, Yogyakarta, Indonesia.
| | - Gertjan J L Kaspers
- Princess Máxima Center for pediatric oncology, Utrecht, Netherlands.
- Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Netherlands, Netherlands.
| | - Ponpon Idjradinata
- Hematology Oncology Division, Department of Child Health Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.
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Alecsa MS, Moscalu M, Trandafir LM, Ivanov AV, Rusu C, Miron IC. Outcomes in Pediatric Acute Lymphoblastic Leukemia-A Single-Center Romanian Experience. J Clin Med 2020; 9:jcm9124052. [PMID: 33333966 PMCID: PMC7765371 DOI: 10.3390/jcm9124052] [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: 11/22/2020] [Revised: 12/09/2020] [Accepted: 12/11/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This study evaluates the main (para)clinical aspects and outcomes in a group of Romanian children diagnosed with acute lymphoblastic leukemia (ALL), under the conditions of antileukemic treatment according to an adapted ALL IC Berlin-Frankfurt-Munster (BFM) 2002 protocol. METHODS We performed a retrospective single-center study of 125 children diagnosed with ALL between 2010 and 2016. Standard forms were used for data collection of variate clinical and paraclinical parameters. RESULTS The children were predominantly male (64.8%) and their median age at diagnosis was 5 years. A total of 107 patients were diagnosed with precursor B-cell acute lymphoblastic leukemia (BCP)-ALL and 18 with T-cell acute lymphoblastic leukemia T-ALL. Multiplex reverse transcription polymerase chain reaction RT-PCR assay for ETV6-RUNX1, BCR-ABL, E2A-PBX1, KMT2A-AFF1, and STIL-TAL1 fusion genes was performed in 111 patients. ETV6-RUNX1 translocation was detected in 18.9% of patients, while BCR-ABL1 and E2A-PBX1 rearrangements were seen in 2.7% and 3.6%, respectively. Complete remission at the end of induction phase was obtained in 89.6% of patients. The overall relapse rate was 11.2%, with 11 early and 3 late relapses. The 5-year overall survival rate in BCP-ALL was 81.6% and in T-ALL 71.4%. CONCLUSIONS The 5-year overall and event-free survival rates in our study were slightly lower than those reported in developed countries, so the patients' outcomes are encouraging.
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Affiliation(s)
- Mirabela-Smaranda Alecsa
- Department Mother and Child Care, Division of Neonatology, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.-S.A.); (A.-V.I.); (C.R.); (I.-C.M.)
- Department of Pediatric Hematology and Oncology, Sf. Maria Children’s Emergency Hospital, 700309 Iasi, Romania
| | - Mihaela Moscalu
- Department of Preventive Medicine and Interdisciplinarity, Division of Informatics and Medical Statistics, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
- Correspondence: (M.M.); (L.-M.T.)
| | - Laura-Mihaela Trandafir
- Department Mother and Child Care, Division of Neonatology, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.-S.A.); (A.-V.I.); (C.R.); (I.-C.M.)
- Department of Pediatrics, Sf. Maria Children’s Emergency Hospital, 700309 Iasi, Romania
- Correspondence: (M.M.); (L.-M.T.)
| | - Anca-Viorica Ivanov
- Department Mother and Child Care, Division of Neonatology, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.-S.A.); (A.-V.I.); (C.R.); (I.-C.M.)
- Department of Pediatrics, Sf. Maria Children’s Emergency Hospital, 700309 Iasi, Romania
| | - Cristina Rusu
- Department Mother and Child Care, Division of Neonatology, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.-S.A.); (A.-V.I.); (C.R.); (I.-C.M.)
- Department of Medical Genetics, Sf. Maria Children’s Emergency Hospital, 700309 Iasi, Romania
| | - Ingrith-Crenguta Miron
- Department Mother and Child Care, Division of Neonatology, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.-S.A.); (A.-V.I.); (C.R.); (I.-C.M.)
- Department of Pediatric Hematology and Oncology, Sf. Maria Children’s Emergency Hospital, 700309 Iasi, Romania
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Pedrosa F, Coustan-Smith E, Zhou Y, Cheng C, Pedrosa A, Lins MM, Pedrosa M, Lucena-Silva N, Ramos AMDL, Vinhas E, Rivera GK, Campana D, Ribeiro RC. Reduced-dose intensity therapy for pediatric lymphoblastic leukemia: long-term results of the Recife RELLA05 pilot study. Blood 2020; 135:1458-1466. [PMID: 32027741 PMCID: PMC7180080 DOI: 10.1182/blood.2019004215] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 01/28/2020] [Indexed: 12/22/2022] Open
Abstract
Treatment-related mortality is common among children with acute lymphoblastic leukemia (ALL) treated in poor-resource settings. We applied a simplified flow cytometric assay to identify patients with precursor B-cell ALL (B-ALL) at very low risk (VLR) of relapse and treated them with a reduced-intensity treatment plan (RELLA05). VLR criteria include favorable presenting features (age ≥ 1 and < 10 years), white blood cell count of <50 ×109/L, lack of extramedullary leukemia, and minimal residual disease level of <0.01% on remission induction day 19. Except for 2 doses of daunorubicin, treatment of patients with VLR B-ALL consisted of a combination of agents with relatively low myelotoxicity profiles, including corticosteroids, vincristine, L-asparaginase, methotrexate, and 6-mercaptopurine. Cyclophosphamide, systemic cytarabine, and central nervous system radiotherapy were not used. Of 454 patients with ALL treated at the Instituto de Medicina Integral Professor Fernando Figueira in Recife, Brazil, between December 2005 and June 2015, 101 were classified as having VLR B-ALL. There were no cases of death resulting from toxicity or treatment abandonment during remission induction. At a median follow-up of 6.6 years, there were 8 major adverse events: 6 relapses, 1 treatment-related death (from septicemia) during remission, and 1 secondary myeloid leukemia. The estimated 5-year event-free and overall survival rates were 92.0% ± 3.9% and 96.0% ± 2.8%, respectively. The 5-year cumulative risk of relapse was 4.24% ± 2.0%. The treatment was well tolerated. Episodes of neutropenia were of short duration. Patients with B-ALL selected by a combination of presenting features and degree of early response can be successfully treated with a mildly myelosuppressive chemotherapy regimen.
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Affiliation(s)
- Francisco Pedrosa
- Department of Pediatric Oncology, Real Hospital Português, Recife, Brazil
| | - Elaine Coustan-Smith
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yinmei Zhou
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - Cheng Cheng
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - Arli Pedrosa
- Department of Pediatric Oncology, Real Hospital Português, Recife, Brazil
| | | | - Marcia Pedrosa
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brazil; and
| | - Norma Lucena-Silva
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brazil; and
| | | | - Ester Vinhas
- Department of Pediatric Oncology, Real Hospital Português, Recife, Brazil
| | | | - Dario Campana
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Raul C Ribeiro
- Department of Global Pediatric Medicine
- Department of Oncology, and
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN
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Rates and trends of childhood acute lymphoblastic leukaemia: an epidemiology study. Sci Rep 2020; 10:6756. [PMID: 32317670 PMCID: PMC7174306 DOI: 10.1038/s41598-020-63528-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 04/01/2020] [Indexed: 12/21/2022] Open
Abstract
Acute lymphoblastic leukaemia (ALL) is the most common childhood cancer and has a high survival rate when properly managed. Prognosis is correlated with many factors such as age, gender, white blood cell (WBC) count, CD10, French-American-British (FAB) classification, and many others. Many of these factors are included in this study as they play a major role in establishing the best treatment protocol. This study aims to demonstrate clinical and laboratory features of childhood ALL in Syria. They were treated at Children’s University Hospital, the only working major cancer centre in Syria at the time of the study. Data of 203 patients who aged 0–14 years were obtained for this study. Most patients (48.8%) aged (5–9) years with a male predominance (60.9%). The major features for ALL included lymphadenopathy (82.9%), presenting with systemic symptoms (74.9%), T-ALL subclass (20.2%), L2 FAB classification (36.1%), low educational levels for fathers (53%) and mothers (56.2%), having a high risk (48.4%), and having a duration of symptoms before evaluation for more than 4 weeks (42.6%). Only three (1.5%) patients had normal full blood counts (FBC) and only one (0.5%) patient had an isolated high WBC count at time of presentation. Most patients had either abnormal platelet count (89.3%) or low haemoglobin level (88.8%) when presenting with only (2.0%) having normal levels for both. This suggests that having normal haemoglobin and platelet count can be used for quick screening in crisis time like in Syria for prioritising patients. Many prognostic factors were significantly different from medical literature which emphasises the importance of local studies in the developping countries. This study included a high prevalence of T-all, L2 FAB classification, high-risk and other variables which require further studies to evaluate the aetiology of these features, especially that treatment protocols may have a higher mortality in developing countries when not adjusted to local variables.
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Zhu Y, Yang R, Cai J, Yu J, Tang Y, Chen Y, Wang N, He H, Wu X, Cheng FWT, Sun L, He Y, Ju X, Tian X, Hu Q, Jin R, Pan K, Fang Y, Zhai X, Jiang H, Li CK. Septicemia after chemotherapy for childhood acute lymphoblastic leukemia in China: A multicenter study CCCG-ALL-2015. Cancer Med 2020; 9:2113-2121. [PMID: 31994344 PMCID: PMC7064088 DOI: 10.1002/cam4.2889] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/12/2020] [Accepted: 01/13/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Septicemia is an important cause of treatment-related mortality and treatment failure in pediatric acute lymphoblastic leukemia (ALL) in developing countries. A multicenter CCCG-ALL-2015 study was conducted in China and factors associated with septicemia and mortality were studied. METHODS Patients participated in CCCG-ALL-2015 study from January 2015 to December 2017 were included. Patients with documented septicemia were identified from the Data Center and additional data were collected. RESULTS A total of 4080 patients were recruited in the study and 527 patients with septicemia were identified (12.9%, 95% CI 11.9%-13.9%). The intermediate risk (IR)/high risk (HR) group had significantly higher incidence of septicemia as compared with low risk (LR) group, 17.1% vs 9.1% (OR 2.07, 95% CI 1.71-2.49, P < .001). Induction phase was the period with majority of septicemia episodes happened, 66.8% in LR and 56.1% in IR/HR groups. Gram-positive bacteria accounted for 54.1%, gram-negative bacteria 44.5%, and fungus 1.4% of positive cultures. Multidrug-resistant organisms were detected in 20.5% of all organisms. The mortality rate after septicemia was 3.4% (95% CI 1.9%-4.9%). Multiple logistic regression identified female gender, comorbid complications, and fungal infection as risk factors associated with mortality. Gram-negative septicemia was associated with higher mortality, 4.9% vs 1.4% (OR 0.28, 95% CI 0.09-0.88, P = .02). There was marked variation in the incidence of septicemia among the 18 centers, from 4.8% to 29.1%. CONCLUSION Overall the incidence and pattern of septicemia in this multicenter study in China was similar to the reports of western countries. The septicemia-related mortality rate was low. There was marked variation in the incidence of septicemia among the centers.
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Affiliation(s)
- Yiping Zhu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Department of Pediatric Hematology/Oncology, West China Second Hospital of Sichuan University, Chengdu, China
| | - Rong Yang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Department of Pediatric Hematology/Oncology, West China Second Hospital of Sichuan University, Chengdu, China
| | - Jiaoyang Cai
- Department of Hematology/Oncology, Shanghai Children's Medical Center, Shanghai Jiaotong University of School of Medicine, Shanghai, China
| | - Jie Yu
- Department of Hematology/Oncology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yanjing Tang
- Department of Hematology/Oncology, Shanghai Children's Medical Center, Shanghai Jiaotong University of School of Medicine, Shanghai, China
| | - Yumei Chen
- State Key Laboratory of Experimental Hematology and Division of Pediatric Blood Diseases Center, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Ningling Wang
- Department of Pediatrics, Anhui Medical University Second Affiliated Hospital, Hefei, China
| | - Hailong He
- Department of Hematology/Oncology, Children's Hospital of Soochow University, Suzhou, China
| | - Xuedong Wu
- Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Frankie W T Cheng
- Department of Paediatrics, Hong Kong Children's Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Lirong Sun
- Department of Pediatrics, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yingyi He
- Department of Hematology/Oncology, Guangzhou Women and Children Health Care Center, Guangzhou, China
| | - Xiuli Ju
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, China
| | - Xin Tian
- Department of Hematology/Oncology, Kunming Children's Hospital, Kunming, China
| | - Qun Hu
- Department of Pediatric Hematology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Runming Jin
- Department of Pediatrics, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kaili Pan
- Department of Hematology/Oncology, Xi'an Northwest Women and Children Hospital, Xian, China
| | - Yongjun Fang
- Department of Hematology/Oncology, Nanjing Children's Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Xiaowen Zhai
- Department of Hematology Oncology, Children's hospital of Fudan University, Shanghai, China
| | - Hui Jiang
- Department of Hematology Oncology, Children's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Chi-Kong Li
- Department of Paediatrics, Hong Kong Children's Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
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Alam A, Kumar A. Impact of financial support and focussed group counselling on treatment abandonment in children with acute lymphoblastic leukaemia. Experience over 22 years from North India. Psychooncology 2018; 28:372-378. [DOI: 10.1002/pon.4951] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/29/2018] [Accepted: 11/23/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Areesha Alam
- Division of Pediatric Hematology‐Oncology, Department of PediatricsKing George's Medical University Lucknow India
| | - Archana Kumar
- Division of Pediatric Hematology‐Oncology, Department of PediatricsKing George's Medical University Lucknow India
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12
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Alam A, Kumar A. Prevalence, predictors, causes of treatment refusal and abandonment in children with acute lymphoblastic leukaemia over 18 years in North India. Treatment phase affecting factors: A step towards better focussed counselling. Cancer Epidemiol 2018; 57:53-59. [DOI: 10.1016/j.canep.2018.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 07/05/2018] [Accepted: 07/18/2018] [Indexed: 11/28/2022]
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Cui L, Li ZG, Chai YH, Yu J, Gao J, Zhu XF, Jin RM, Shi XD, Zhang LP, Gao YJ, Zhang RD, Zheng HY, Hu SY, Cui YH, Zhu YP, Zou Y, Ng MHL, Xiao Y, Li JH, Zhang YH, He HL, Xian Y, Wang TY, Li CK, Wu MY. Outcome of children with newly diagnosed acute lymphoblastic leukemia treated with CCLG-ALL 2008: The first nation-wide prospective multicenter study in China. Am J Hematol 2018; 93:913-920. [PMID: 29675840 DOI: 10.1002/ajh.25124] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 04/13/2018] [Accepted: 04/17/2018] [Indexed: 01/24/2023]
Abstract
Acute lymphoblastic leukemia (ALL) is the most common malignancy among children. The trial Chinese Children Leukemia Group (CCLG)-ALL 2008 was a prospective clinical trial designed to improve treatment outcome of childhood ALL through the first nation-wide collaborative study in China. Totally 2231 patients were recruited from ten tertiary hospitals in eight cities. The patients were stratified according to clinical-biological characteristics and early treatment response. Standard risk (SR) and intermediate risk (IR) groups were treated with a modified BFM based protocol, and there was 25%-50% dose reduction during intensification phases in the SR group. Patients in high risk (HR) group received a more intensive maintenance treatment. Minimal residual disease (MRD) monitoring with treatment adjustment was performed in two hospitals (the MRD group). Complete remission (CR) was achieved in 2100 patients (94.1%). At five years, the estimate for overall survival (OS) and event-free survival (EFS) of the whole group was 85.3% and 79.9%, respectively. The cumulative incidence of relapse (CIR) was 15.3% at five years. The OS, EFS and CIR for the SR group were 91.5%, 87.9%, and 9.7%, respectively. The outcome of the MRD group is better than the non-MRD group (5y-EFS: 82.4% vs 78.3%, P = .038; 5y-CIR: 10.7% vs 18.0%, P < .001). Our results demonstrated that the large-scale multicenter trial for pediatric ALL was feasible in China. Dose reduction in the SR group could achieve high EFS. MRD-based risk stratification might improve the treatment outcome for childhood ALL.
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Affiliation(s)
- Lei Cui
- Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Hematology Oncology Center; Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- Hematology and Oncology Laboratory, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zhi-Gang Li
- Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Hematology Oncology Center; Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- Hematology and Oncology Laboratory, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yi-Huan Chai
- Department of Hematology-Oncology, Children's Hospital of Soochow University, Soochow, China
| | - Jie Yu
- Department of Hematology Oncology, Children's Hospital of Chongqing Medical University; Ministry of Education Key Laboratory of Child Development and Disorder, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Ju Gao
- Department of Pediatrics, West China Second University Hospital, Sichuan University; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Xiao-Fan Zhu
- Department of Pediatrics, Institute of Hematology and Hospital of Blood Disease, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China
| | - Run-Ming Jin
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao-Dong Shi
- Department of Hematology and Oncology, Capital Institute of Pediatrics, Beijing, China
| | - Le-Ping Zhang
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
| | - Yi-Jin Gao
- Department of Hematology, Children's Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Rui-Dong Zhang
- Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Hematology Oncology Center; Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Hu-Yong Zheng
- Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Hematology Oncology Center; Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Shao-Yan Hu
- Department of Hematology-Oncology, Children's Hospital of Soochow University, Soochow, China
| | - Ying-Hui Cui
- Department of Hematology Oncology, Children's Hospital of Chongqing Medical University; Ministry of Education Key Laboratory of Child Development and Disorder, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yi-Ping Zhu
- Department of Pediatrics, West China Second University Hospital, Sichuan University; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Yao Zou
- Department of Pediatrics, Institute of Hematology and Hospital of Blood Disease, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China
| | - Margaret H L Ng
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Yan Xiao
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun-Hui Li
- Department of Hematology and Oncology, Capital Institute of Pediatrics, Beijing, China
| | - Yong-Hong Zhang
- Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Hematology Oncology Center; Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Hai-Long He
- Department of Hematology-Oncology, Children's Hospital of Soochow University, Soochow, China
| | - Ying Xian
- Department of Hematology Oncology, Children's Hospital of Chongqing Medical University; Ministry of Education Key Laboratory of Child Development and Disorder, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Tian-You Wang
- Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Hematology Oncology Center; Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Chi-Kong Li
- Department of Pediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong; The Hong Kong Pediatric Hematology and Oncology Study Group, Hong Kong, China
| | - Min-Yuan Wu
- Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Hematology Oncology Center; Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Impact of an animal-assisted therapy programme on physiological and psychosocial variables of paediatric oncology patients. PLoS One 2018; 13:e0194731. [PMID: 29617398 PMCID: PMC5884536 DOI: 10.1371/journal.pone.0194731] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 03/08/2018] [Indexed: 11/19/2022] Open
Abstract
The objective of this study was to propose an intervention and safety protocol for performing animal-assisted therapy (AAT) and evaluating its efficacy in children under outpatient oncological treatment based on psychological, physiological, and quality of life indicators for the children and caregivers. The sample consisted of 24 children diagnosed with leukaemia and solid tumours (58% girls with a mean age of 8.0 years) who underwent an AAT programme consisting of three 30-min sessions in an open group. Two dogs (one Labrador retriever and one golden retriever) were used, and activities such as sensory stimulation, gait training, and socialization were conducted. The exclusion criteria were severe mental problems, inability to answer the questions included in the instruments used, allergy to animals, unavailability/lack of interest, isolation precaution, surgical wound, use of invasive devices, ostomy, no current blood count for evaluation, neutropaenia, infection, fever, diarrhoea, vomiting, respiratory symptoms at the beginning of the intervention or 1 week before the intervention, hospitalization or scheduled surgery, and non-completion of the AAT programme. The variables analysed using validated self or other evaluations were stress, pain, mood, anxiety, depression, quality of life, heart rate, and blood pressure. A quasi-experimental study design was used. We observed a decrease in pain (p = 0.046, d = –0.894), irritation (p = 0.041, d = –0.917), and stress (p = 0.005; d = –1.404) and a tendency towards improvement of depressive symptoms (p = 0.069; d = –0.801). Among the caregivers, an improvement was observed in anxiety (p = 0.007, d = –1.312), mental confusion (p = 0.006, d = –1.350), and tension (p = 0.006, d = –1.361). Therefore, the selection criteria and care protocols used for the AAT programme in the oncological context were adequate, and the programme was effective.
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15
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Alvarez E, Seppa M, Rivas S, Fuentes L, Valverde P, Antillón-Klussmann F, Castellanos M, Sweet-Cordero EA, Messacar K, Kurap J, Bustamante M, Howard SC, Efron B, Luna-Fineman S. Improvement in treatment abandonment in pediatric patients with cancer in Guatemala. Pediatr Blood Cancer 2017; 64. [PMID: 28423236 DOI: 10.1002/pbc.26560] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 02/12/2017] [Accepted: 02/19/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Treatment refusal and abandonment are major causes of treatment failure for children with cancer in low- and middle-income countries (LMICs), like Guatemala. This study identified risk factors for and described the intervention that decreased abandonment. METHODS This was a retrospective study of Guatemalan children (0-18 years) with cancer treated at the Unidad Nacional de Oncología Pediátrica (UNOP), 2001-2008, using the Pediatric Oncology Network Database. Treatment refusal was a failure to begin treatment and treatment abandonment was a lapse of 4 weeks or longer in treatment. The impact of medicina integral, a multidisciplinary psychosocial intervention team at UNOP was evaluated. Cox proportional hazards analysis identified the effect of demographic and clinical factors on abandonment. Kaplan-Meier analysis estimated the survival. RESULTS Of 1,789 patients, 21% refused or abandoned treatment. Abandonment decreased from 27% in 2001 to 7% in 2008 following the implementation of medicina integral. Factors associated with increased risk of refusal and abandonment: greater distance to the centre (P < 0.001), younger age (P = 0.017) and earlier year of diagnosis (P < 0.001). Indigenous race/ethnicity (P = 0.002) was associated with increased risk of abandonment alone. Abandonment correlated with decreased overall survival: 0.57 ± 0.02 (survival ± standard error) for those who completed therapy versus 0.06 ± 0.02 for those who abandoned treatment (P < 0.001) at 8.3 years. CONCLUSION This study identified distance, age, year of diagnosis and indigenous race/ethnicity as risk factors for abandonment. A multidisciplinary intervention reduced abandonment and can be replicated in other LMICs.
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Affiliation(s)
- Elysia Alvarez
- Division of Hematology/Oncology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Midori Seppa
- Stanford University School of Medicine, Palo Alto, California
| | - Silvia Rivas
- Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | - Lucia Fuentes
- Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | | | | | | | - E Alejandro Sweet-Cordero
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, UCSF Benioff Children's Hospital, San Francisco, California
| | - Kevin Messacar
- Section of Hospital Medicine and Infectious Diseases, Department of Pediatrics, University of Colorado/Children's Hospital Colorado, Aurora, Colorado
| | - John Kurap
- Hilo Bay Clinic, Community Health Center, Hilo, Hawaii
| | | | - Scott C Howard
- School of Health Studies, University of Memphis, Tennessee
| | - Bradley Efron
- Department of Statistics and Biostatistics, Stanford University, Palo Alto, California
| | - Sandra Luna-Fineman
- Division of Hematology/Oncology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California.,Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
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Pedrosa F, Shaikh F, Rivera G, Ribeiro R, Qaddoumi I. The Impact of Prospective Telemedicine Implementation in the Management of Childhood Acute Lymphoblastic Leukemia in Recife, Brazil. Telemed J E Health 2017; 23:863-867. [PMID: 28422613 DOI: 10.1089/tmj.2016.0273] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND A gap in childhood cancer outcomes remains between developed and developing countries. Persistence of this gap may be caused by financial, social, or educational disparities. Twinning and distance learning initiatives may improve such disparities. Integrating telemedicine into pediatric oncology twinning programs enhances education and facilitates patient-centered capacity building. MATERIALS AND METHODS We performed an analysis of Web-based meetings held from August 2005 through July 2009 between the International Outreach Program at St. Jude Children's Research Hospital and the Instituto Materno Infantil de Pernambuco (IMIP) in Recife, Brazil. We determined the effect of these online conferences on the development and implementation of an innovative protocol for children with acute lymphoblastic leukemia (ALL) at IMIP. RESULTS Meetings occurred in 45 months of the 48-month study period with an average of two meetings per month. A total of 163 new patients were discussed during the study period; we retrieved documentation of patient-related discussions for 147 of them, constituting 286 discussions. On average, each patient was discussed 1.9 times (range, 1-15 discussions/patient). Compared with that of the era predating the online meetings (1993-2005), overall mortality, early death, and relapse of patients with ALL decreased after the telemedicine program was instituted at IMIP. DISCUSSION Personal dedication and institutional support are essential for successful telemedicine initiatives. Documentation and archival of meetings are important for accurately measuring outcomes and developing methods for improved care. CONCLUSIONS Integration of telemedicine into twinning programs facilitates communication about interventions, leading to improved outcomes of pediatric patients with cancer.
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Affiliation(s)
- Francisco Pedrosa
- 1 Department of Oncology, Instituto Materno-Infantil de Pernambuco , Recife, Brazil
| | - Faisal Shaikh
- 2 Department of Internal Medicine, Weill Cornell University , New York, New York
| | - Gaston Rivera
- 3 Department of Global Pediatric Medicine, St. Jude Children's Research Hospital , Memphis, Tennessee
| | - Raul Ribeiro
- 3 Department of Global Pediatric Medicine, St. Jude Children's Research Hospital , Memphis, Tennessee
| | - Ibrahim Qaddoumi
- 3 Department of Global Pediatric Medicine, St. Jude Children's Research Hospital , Memphis, Tennessee
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Graham H, Tokhi M, Duke T. Scoping review: strategies of providing care for children with chronic health conditions in low- and middle-income countries. Trop Med Int Health 2016; 21:1366-1388. [PMID: 27554327 DOI: 10.1111/tmi.12774] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To identify and review strategies of providing care for children living with chronic health conditions in low- and middle-income countries. METHODS We searched MEDLINE and Cochrane EPOC databases for papers evaluating strategies of providing care for children with chronic health conditions in low- or middle-income countries. Data were systematically extracted using a standardised data charting form, and analysed according to Arksey and O'Malley's 'descriptive analytical method' for scoping reviews. RESULTS Our search identified 71 papers addressing eight chronic conditions; two chronic communicable diseases (HIV and TB) accounted for the majority of papers (n = 37, 52%). Nine (13%) papers reported the use of a package of care provision strategies (mostly related to HIV and/or TB in sub-Saharan Africa). Most papers addressed a narrow aspect of clinical care provision, such as patient education (n = 23) or task-shifting (n = 15). Few papers addressed the strategies for providing care at the community (n = 10, 15%) or policy (n = 6, 9%) level. Low-income countries were under-represented (n = 24, 34%), almost exclusively involving HIV interventions in sub-Saharan Africa (n = 21). Strategies and summary findings are described and components of future models of care proposed. CONCLUSIONS Strategies that have been effective in reducing child mortality globally are unlikely to adequately address the needs of children with chronic health conditions in low- and middle-income settings. Current evidence mostly relates to disease-specific, narrow strategies, and more research is required to develop and evaluate the integrated models of care, which may be effective in improving the outcomes for these children.
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Affiliation(s)
- Hamish Graham
- Centre for International Child Health, Royal Children's Hospital, University of Melbourne, MCRI, Melbourne, VIC, Australia.
| | - Mariam Tokhi
- Victorian Aboriginal Health Service, Melbourne, VIC, Australia
| | - Trevor Duke
- Centre for International Child Health, Royal Children's Hospital, University of Melbourne, MCRI, Melbourne, VIC, Australia
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Abstract
PURPOSE OF REVIEW The prognosis for children with the most common childhood malignancy, acute lymphoblastic leukemia (ALL), has improved dramatically. However, the burden of therapy can be substantial, with long-term side-effects, and certain subgroups continue to have a poor outcome. RECENT FINDINGS The recent discovery of new genetic alterations in high-risk subsets provides targets for precision medicine-based interventions using existing Food and Drug Administration approved agents. Novel immunotherapeutic approaches are being deployed in relapsed ALL, one of the leading causes of cancer cell death in children. Moreover, genomic analysis has charted the evolution of tumor subclones, and relapse-specific alterations now provide a mechanistic explanation for drug resistance, setting the stage for targeted therapy. There is greater recognition that host factors - genetic polymorphisms - influence cancer risk, response to therapy, and toxicity. In the future, it is anticipated that they will be integrated into clinical decision making to maximize cure and minimize side-effects. Recent efforts to limit prophylactic central nervous system irradiation have been successful, thereby sparing many children late neurocognitive impairments. SUMMARY Integration of advances in precision medicine approaches and novel agents will continue to increase the cure rate and decrease the burden of therapy for childhood ALL.
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Zong J, Wang D, Jiao W, Zhang L, Bao G, Ho CT, Hou R, Wan X. Oleiferasaponin C6 from the seeds of Camellia oleifera Abel.: a novel compound inhibits proliferation through inducing cell-cycle arrest and apoptosis on human cancer cell lines in vitro. RSC Adv 2016. [DOI: 10.1039/c6ra14467e] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Oleiferasaponin C6 was isolated from Camellia oleifera Abel. and inhibits proliferation through inducing cell-cycle arrest and apoptosis on cancer cell lines in vitro.
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Affiliation(s)
- Jianfa Zong
- State Key Laboratory of Tea Plant Biology and Utilization
- Anhui Agricultural University
- Hefei 230036
- China
| | - Dongxu Wang
- State Key Laboratory of Tea Plant Biology and Utilization
- Anhui Agricultural University
- Hefei 230036
- China
| | - Weiting Jiao
- State Key Laboratory of Tea Plant Biology and Utilization
- Anhui Agricultural University
- Hefei 230036
- China
| | - Liang Zhang
- State Key Laboratory of Tea Plant Biology and Utilization
- Anhui Agricultural University
- Hefei 230036
- China
| | - Guanhu Bao
- State Key Laboratory of Tea Plant Biology and Utilization
- Anhui Agricultural University
- Hefei 230036
- China
| | - Chi-Tang Ho
- Department of Food Science
- Rutgers University
- New Brunswick
- USA
| | - Ruyan Hou
- State Key Laboratory of Tea Plant Biology and Utilization
- Anhui Agricultural University
- Hefei 230036
- China
| | - Xiaochun Wan
- State Key Laboratory of Tea Plant Biology and Utilization
- Anhui Agricultural University
- Hefei 230036
- China
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20
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Ribeiro RC, Antillon F, Pedrosa F, Pui CH. Global Pediatric Oncology: Lessons From Partnerships Between High-Income Countries and Low- to Mid-Income Countries. J Clin Oncol 2015; 34:53-61. [PMID: 26578620 DOI: 10.1200/jco.2015.61.9148] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Partnerships between medical institutions in high-income countries (HICs) and low- to mid-income countries (LMICs) have succeeded in initiating and expanding pediatric cancer control efforts. The long-term goal is consistently a sustainable national pediatric cancer program. Here, we review the elements required for successful implementation, development, and long-term sustainability of pediatric cancer programs in LMICs that first arise as partnerships with institutions in HICs. Although plans must be adapted to each country's resources, certain components are unfailingly necessary. First, an essential step is provision of treatment regardless of ability to pay. Second, financial support for program development and long-term sustainability must be sought from sources both international and local, public and private. A local leader, typically a well-trained pediatric oncologist who devotes full-time effort to the project, should direct medical care and collaborate with hospital, governmental, and community leadership and international agencies. Third, nurses must be trained in pediatric cancer care and allowed to practice this specialty full-time. It is also essential to develop a grassroots organization, such as a foundation, dedicated solely to pediatric oncology. Its members must be trained and educated to provide pediatric cancer advocacy, fundraising, and (in concert with government) program sustainability. Finally, a project mentor in the HIC is crucial and should explore the possibility of collaborative research in the LMIC, which may offer significant opportunities. Relationships between the partnership's leaders and influential individuals in the community, hospital, grassroots foundation, and government will lay the foundation for productive collaboration and a sustainable pediatric oncology program.
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Affiliation(s)
- Raul C Ribeiro
- Raul C. Ribeiro and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Federico Antillon, Unidad Nacional de Oncologia Pediatrica and Universidad Francisco Marroquin, Guatemala City, Guatemala; and Francisco Pedrosa, Instituto de Medicina Integral Fernando Figueira, Recife, Brazil.
| | - Federico Antillon
- Raul C. Ribeiro and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Federico Antillon, Unidad Nacional de Oncologia Pediatrica and Universidad Francisco Marroquin, Guatemala City, Guatemala; and Francisco Pedrosa, Instituto de Medicina Integral Fernando Figueira, Recife, Brazil
| | - Francisco Pedrosa
- Raul C. Ribeiro and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Federico Antillon, Unidad Nacional de Oncologia Pediatrica and Universidad Francisco Marroquin, Guatemala City, Guatemala; and Francisco Pedrosa, Instituto de Medicina Integral Fernando Figueira, Recife, Brazil
| | - Ching-Hon Pui
- Raul C. Ribeiro and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Federico Antillon, Unidad Nacional de Oncologia Pediatrica and Universidad Francisco Marroquin, Guatemala City, Guatemala; and Francisco Pedrosa, Instituto de Medicina Integral Fernando Figueira, Recife, Brazil
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21
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Ceppi F, Antillon F, Pacheco C, Sullivan CE, Lam CG, Howard SC, Conter V. Supportive medical care for children with acute lymphoblastic leukemia in low- and middle-income countries. Expert Rev Hematol 2015; 8:613-26. [DOI: 10.1586/17474086.2015.1049594] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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22
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Kulkarni KP. In the realms of future: new frontiers of 'techno-oncology' as a platform for global improvement in the outcomes of childhood cancer. Expert Rev Hematol 2014; 8:1-4. [PMID: 25537882 DOI: 10.1586/17474086.2015.995623] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The survival outcome of childhood cancers in developing nations has failed to keep pace with that of developed nations. Technological advances offer a unique and radical opportunity to develop programs and strategies to improve outcomes of childhood cancer globally. The novel field of 'techno-oncology' has a broad scope and the potential to phenomenally impact, revamp and model the care of pediatric cancer patients in the developing world. Many frontiers and opportunities in the area remain to be explored as well as many challenges to be surmounted.
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Affiliation(s)
- Ketan P Kulkarni
- Department of Pediatrics, Division of Hematology/Oncology, IWK Health Centre, 5850/5980 University Avenue, Halifax, NS B3K 6R8, Canada
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