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Roganovic J, Haupt R, Bárdi E, Hjorth L, Michel G, Pavasovic V, Scheinemann K, van der Pal HJ, Zadravec Zaletel L, Amariutei AE, Skinner R. Late Adverse Effects after Treatment for Childhood Acute Leukemia. Acta Med Acad 2024; 53:59-80. [PMID: 38984700 PMCID: PMC11237916 DOI: 10.5644/ama2006-124.438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 03/25/2024] [Indexed: 07/11/2024] Open
Abstract
The aim of this review is to raise awareness and knowledge among healthcare professionals and policymakers about late adverse effects in survivors of childhood leukemia. With contemporary treatment, over 90% of children with acute lymphoblastic leukemia (ALL) and over 60% with acute myeloid leukemia (AML) are cured. Large cohort studies demonstrate that 20% of ALL and most AML survivors have at least one chronic health condition by 20-25 years after diagnosis. These are life-changing or threatening in some survivors and contribute to increased premature mortality. We describe the frequency, causes, clinical features, and natural history of the most frequent and severe late adverse effects in childhood leukemia survivors, including subsequent malignant neoplasms, metabolic toxicity, gonadotoxicity and impaired fertility, endocrinopathy and growth disturbances, bone toxicity, central and peripheral neurotoxicity, cardiotoxicity, psychosocial late effects, accelerated ageing and late mortality. The wide range of late effects in survivors of haemopoietic stem cell transplant is highlighted. Recent developments informing the approach to long-term survivorship care are discussed, including electronic personalized patient-specific treatment summaries and care plans such as the Survivor Passport (SurPass), surveillance guidelines and models of care. The importance of ongoing vigilance is stressed given the increasing use of novel targeted drugs with limited experience of long-term outcomes. CONCLUSION: It is vital to raise awareness of the existence and severity of late effects of childhood leukemia therapy among parents, patients, health professionals, and policymakers. Structured long-term surveillance recommendations are necessary to standardize follow-up care.
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Affiliation(s)
- Jelena Roganovic
- Department of Pediatric Hematology and Oncology, Children's Hospital Zagreb, Zagreb, Croatia; Faculty of Biotechnology and Drug Development, University of Rijeka, Rijeka, Croatia
| | - Riccardo Haupt
- Epidemiology and Biostatistics Unit and DOPO Clinic, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Edit Bárdi
- St. Anna Childrens Hospital, Wien; Department of Pediatrics and Adolescent Medicine, Johannes Kepler University Linz, Kepler University Hospital, Linz, Austria
| | - Lars Hjorth
- Department of Pediatrics, Skane University Hospital; Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Gisela Michel
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Vesna Pavasovic
- Department of Paediatric Haematology and Oncology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - Katrin Scheinemann
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland; Division of Hematology-Oncology, Children's Hospital of Eastern Switzerland, St Gallen, Switzerland; Department of Pediatrics, McMaster Children's Hospital and McMaster University, Hamilton, Canada
| | | | - Lorna Zadravec Zaletel
- Radiotherapy Department, Institute of Oncology Ljubljana, Ljubljana; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia,
| | | | - Roderick Skinner
- Department of Paediatric and Adolescent Haematology and Oncology, Great North Children's Hospital, Royal Victoria Infirmary; Translational and Clinical Research Institute, and Centre for Cancer, Newcastle University, Newcastle upon Tyne, United
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Lovell AL, Gardiner B, Henry L, Bate JM, Brougham MFH, Iniesta RR. The evolution of nutritional care in children and young people with acute lymphoblastic leukaemia: a narrative review. J Hum Nutr Diet 2024. [PMID: 38185902 DOI: 10.1111/jhn.13273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 12/08/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Acute lymphoblastic leukaemia (ALL) is the most common paediatric malignancy in the world. Advances in treatment protocols have resulted in survival rates of >80% in most high-income countries (HIC); however, children and young people (CYP) with ALL continue to face significant nutrition-related challenges during treatment. METHODS This narrative review outlines the changing landscape of treatment and survivorship for CYP with ALL and the advances in nutrition knowledge that call for changes to clinical nutrition practice. RESULTS The incidence of ALL has remained stable in HIC; however, there have been significant advances in survival over the past 30 years. Overweight and obesity are increasingly prevalent in CYP with ALL at diagnosis, during treatment and in survivorship. Coupled with poor diet quality, high-energy and saturated fat intakes, altered eating behaviours and inactivity, this necessitates the need for a shift in nutrition intervention. Undernutrition remains a concern for CYP with high-risk treatment protocols where oral or enteral nutrition support remains a cornerstone of maintaining nutrition status. CONCLUSIONS With improved treatment protocols and high survival rates, a shift to focusing on diet quality, prevention of excessive weight gain and obesity during treatment and survivorship is necessary.
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Affiliation(s)
- Amy L Lovell
- Department of Nutrition and Dietetics, The University of Auckland, Faculty of Medical and Health Sciences, Auckland, New Zealand
- Starship Blood and Cancer Centre, Starship Child Health, Auckland, New Zealand
| | - Breeana Gardiner
- Department of Nutrition and Dietetics, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Louise Henry
- Department of Nutrition and Dietetics, Royal Marsden NHS Foundation Trust, Surrey, UK
| | - Jessica M Bate
- Department of Paediatric Oncology, Southampton Children's Hospital, Southampton, UK
| | - Mark F H Brougham
- Department of Haematology and Oncology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Raquel Revuelta Iniesta
- Children's Health and Exercise Research Centre (CHERC), Faculty of Health and Life Sciences, Public Health and Sport Sciences, Medical School, St Luke's Campus, University of Exeter, Exeter, UK
- Child Life and Health, University of Edinburgh, Edinburgh, UK
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Yafour N, Hamzy F, Elkababri M, Yakoub-Agha I, Bekadja MA. [Acute lymphoblastic leukemia in developing countries: Management from the transplant indication (allo/auto) until post-transplant follow-up. Guidelines from the SFGM-TC]. Bull Cancer 2023; 110:S30-S38. [PMID: 35562231 DOI: 10.1016/j.bulcan.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 11/26/2022]
Abstract
Management of acute lymphoblastic leukemia (ALL) patients in countries with limited resources depends on the means of prognostic stratification, available treatment and logistics. During the 12th annual harmonization workshops of the francophone Society of bone marrow transplantation and cellular therapy (SFGM-TC), a designated working group reviewed the literature in order to elaborate unified guidelines for allogeneic hematopoietic cell transplantation (Allo-HCT) in this disease. Conventional poor prognostic factors can be used to determine the indication of allo-HCT in first remission. Patients lacking a HLA-matched related donor can be allografted with a haploidentical donor allo-HCT if available. Chemotherapy based conditioning regimen can be used if TBI is not available, because the probability to find a radiotherapy department with the capacity for total body irradiation is low. For patients with Philadelphia chromosome positive (Phi+) ALL, post-transplantation tyrosine kinase inhibitors as a systematic maintenance strategy is recommended. Autologous HCT is optional for Phi+ ALL patients with negative minimal residual disease, who not eligible for allo-HCT. Patients with refractory/relapsed disease have a poor prognosis which highlights the importance of acquiring in the future new therapies such as: blinatumumab, inotuzumab, and CAR-T cells.
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Affiliation(s)
- Nabil Yafour
- Université d'Oran 1, Ahmed-Ben-Bella, établissement hospitalier et universitaire 1(er) Novembre 1954, faculté de médecine, service d'hématologie et de thérapie cellulaire, BP 4166 Ibn-Rochd, 31000 Oran, Algérie.
| | - Faty Hamzy
- Hôpital Cheikh-Zaïd universitaire international, service d'hématologie et greffe, cité Al-Irfane-Hay Ryad avenue Allal-al-Fassi, 10000 Rabat, Maroc
| | - Maria Elkababri
- Hôpital d'enfants de Rabat, université Mohammed V de Rabat, service d'hématologie et oncologie pédiatrique, Rabat, Maroc
| | | | - Mohamed Amine Bekadja
- Université d'Oran 1, Ahmed-Ben-Bella, établissement hospitalier et universitaire 1(er) Novembre 1954, faculté de médecine, service d'hématologie et de thérapie cellulaire, BP 4166 Ibn-Rochd, 31000 Oran, Algérie
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Hailu A, Mekasha A, Hailu D, Fentie AM, Korones DN, Gidey AM. Impact of Delay Prior to Treatment in Ethiopian Children with Acute Lymphoblastic Leukemia. Pediatric Health Med Ther 2023; 14:147-157. [PMID: 37197228 PMCID: PMC10184856 DOI: 10.2147/phmt.s406181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/01/2023] [Indexed: 05/19/2023] Open
Abstract
Introduction More than 85% of childhood malignancies occur in developing countries with less than a 30% cure rate as opposed to more than 80% cure rate in developed countries. This disproportionately significant difference might be due to delays in diagnosis, treatment initiation, lack of adequate supportive care, and treatment abandonment. We aimed to determine the impact of overall treatment delay on induction mortality of children with acute lymphoblastic leukemia treated at Tikur Anbessa specialized hospital (TASH). Methods A cross-sectional study was conducted among children who were treated from 2016 to 2019. Children with Down syndrome and relapsed leukemia were excluded from this study. Results A total of 166 children were included; most patients were males (71.7%). The mean age at diagnosis was 5.9 years. The median time interval from the onset of symptoms to the first TASH visit was 30 days and the median period from TASH's first clinic visit to diagnosis was 11 days. The median time to initiate chemotherapy after diagnosis was 8 days. The total median time from the first onset of symptoms to chemotherapy initiation was 53.5 days. Induction mortality was 31.3%. High-risk ALL and patients with an overall delay between 30 and 90 days were more likely to experience induction mortality. Discussion Patient and healthcare system delay is high compared to most studies done and a significant association has been noted with induction mortality. Efforts to expand the pediatric oncology service in the country and efficient diagnostic and treatment approach need to be established to reduce mortality associated with overall delay.
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Affiliation(s)
- Abel Hailu
- Department of Pediatrics and Child Health, Addis Ababa University Addis Ababa, Addis Ababa, Ethiopia
- Correspondence: Abel Hailu, Email
| | - Amha Mekasha
- Department of Pediatrics and Child Health, Addis Ababa University Addis Ababa, Addis Ababa, Ethiopia
| | - Daniel Hailu
- Department of Pediatrics and Child Health, Addis Ababa University Addis Ababa, Addis Ababa, Ethiopia
| | - Atalay Mulu Fentie
- Department of Pharmacology and Clinical Pharmacy, Addis Ababa University, Addis Ababa, Ethiopia
| | - David N Korones
- Department of Pediatrics, University of Rochester, New York, NY, USA
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Botta L, Gatta G, Capocaccia R, Stiller C, Cañete A, Dal Maso L, Innos K, Mihor A, Erdmann F, Spix C, Lacour B, Marcos-Gragera R, Murray D, Rossi S, Hackl M, Van Eycken E, Van Damme N, Valerianova Z, Sekerija M, Scoutellas V, Demetriou A, Dušek L, Krejci D, Storm H, Mägi M, Innos K, Paapsi K, Malila N, Pitkäniemi J, Jooste V, Clavel J, Poulalhon C, Lacour B, Desandes E, Monnereau A, Erdmann F, Spix C, Katalinic A, Petridou E, Markozannes G, Garami M, Birgisson H, Murray D, Walsh PM, Mazzoleni G, Vittadello F, Cuccaro F, Galasso R, Sampietro G, Rosso S, Gasparotto C, Maifredi G, Ferrante M, Torrisi A, Sutera Sardo A, Gambino ML, Lanzoni M, Ballotari P, Giacomazzi E, Ferretti S, Caldarella A, Manneschi G, Gatta G, Sant M, Baili P, Berrino F, Botta L, Trama A, Lillini R, Bernasconi A, Bonfarnuzzo S, Vener C, Didonè F, Lasalvia P, Del Monego G, Buratti L, Serraino D, Taborelli M, Capocaccia R, De Angelis R, Demuru E, Di Benedetto C, Rossi S, Santaquilani M, Venanzi S, Tallon M, Boni L, Iacovacci S, Russo AG, Gervasi F, Spagnoli G, Cavalieri d'Oro L, Fusco M, Vitale MF, Usala M, Vitale F, Michiara M, Chiranda G, Sacerdote C, Maule M, Cascone G, Spata E, Mangone L, Falcini F, Cavallo R, Piras D, Dinaro Y, Castaing M, Fanetti AC, Minerba S, Candela G, Scuderi T, Rizzello RV, Stracci F, Tagliabue G, Rugge M, Brustolin A, Pildava S, Smailyte G, Azzopardi M, Johannesen TB, Didkowska J, Wojciechowska U, Bielska-Lasota M, Pais A, Ferreira AM, Bento MJ, Miranda A, Safaei Diba C, Zadnik V, Zagar T, Sánchez-Contador Escudero C, Franch Sureda P, Lopez de Munain A, De-La-Cruz M, Rojas MD, Aleman A, Vizcaino A, Almela F, Marcos-Gragera R, Sanvisens A, Sanchez MJ, Chirlaque MD, Sanchez-Gil A, Guevara M, Ardanaz E, Cañete-Nieto A, Peris-Bonet R, Galceran J, Carulla M, Kuehni C, Redmond S, Visser O, Karim-Kos H, Stevens S, Stiller C, Gavin A, Morrison D, Huws DW. Long-term survival and cure fraction estimates for childhood cancer in Europe (EUROCARE-6): results from a population-based study. Lancet Oncol 2022; 23:1525-1536. [DOI: 10.1016/s1470-2045(22)00637-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 11/17/2022]
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Vicente-Garcés C, Esperanza-Cebollada E, Montesdeoca S, Torrebadell M, Rives S, Dapena JL, Català A, Conde N, Camós M, Vega-García N. Technical Validation and Clinical Utility of an NGS Targeted Panel to Improve Molecular Characterization of Pediatric Acute Leukemia. Front Mol Biosci 2022; 9:854098. [PMID: 35463953 PMCID: PMC9021638 DOI: 10.3389/fmolb.2022.854098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/18/2022] [Indexed: 12/03/2022] Open
Abstract
Development of next-generation sequencing (NGS) has provided useful genetic information to redefine diagnostic, prognostic, and therapeutic strategies for the management of acute leukemia (AL). However, the application in the clinical setting is still challenging. Our aim was to validate the AmpliSeq™ for Illumina® Childhood Cancer Panel, a pediatric pan-cancer targeted NGS panel that includes the most common genes associated with childhood cancer, and assess its utility in the daily routine of AL diagnostics. In terms of sequencing metrics, the assay reached all the expected values. We obtained a mean read depth greater than 1000×. The panel demonstrated a high sensitivity for DNA (98.5% for variants with 5% variant allele frequency (VAF)) and RNA (94.4%), 100% of specificity and reproducibility for DNA and 89% of reproducibility for RNA. Regarding clinical utility, 49% of mutations and 97% of the fusions identified were demonstrated to have clinical impact. Forty-one percent of mutations refined diagnosis, while 49% of them were considered targetable. Regarding RNA, fusion genes were more clinically impactful in terms of refining diagnostic (97%). Overall, the panel found clinically relevant results in the 43% of patients tested in this cohort. To sum up, we validated a reliable and reproducible method to refine pediatric AL diagnosis, prognosis, and treatment, and demonstrated the feasibility of incorporating a targeted NGS panel into pediatric hematology practice.
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Affiliation(s)
- Clara Vicente-Garcés
- Hematology Laboratory, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Barcelona, Spain
- Leukemia and Other Pediatric Hemopathies, Developmental Tumors Biology Group, Institut de Recerca Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Elena Esperanza-Cebollada
- Hematology Laboratory, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Barcelona, Spain
- Leukemia and Other Pediatric Hemopathies, Developmental Tumors Biology Group, Institut de Recerca Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Sara Montesdeoca
- Hematology Laboratory, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Barcelona, Spain
- Leukemia and Other Pediatric Hemopathies, Developmental Tumors Biology Group, Institut de Recerca Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Montserrat Torrebadell
- Hematology Laboratory, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Barcelona, Spain
- Leukemia and Other Pediatric Hemopathies, Developmental Tumors Biology Group, Institut de Recerca Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Susana Rives
- Leukemia and Other Pediatric Hemopathies, Developmental Tumors Biology Group, Institut de Recerca Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
- Pediatric Hematology and Oncology Department, Hospital Sant Joan de Déu Barcelona, University of Barcelona, Barcelona, Spain
| | - José Luis Dapena
- Leukemia and Other Pediatric Hemopathies, Developmental Tumors Biology Group, Institut de Recerca Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Pediatric Hematology and Oncology Department, Hospital Sant Joan de Déu Barcelona, University of Barcelona, Barcelona, Spain
| | - Albert Català
- Leukemia and Other Pediatric Hemopathies, Developmental Tumors Biology Group, Institut de Recerca Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
- Pediatric Hematology and Oncology Department, Hospital Sant Joan de Déu Barcelona, University of Barcelona, Barcelona, Spain
| | - Nuria Conde
- Leukemia and Other Pediatric Hemopathies, Developmental Tumors Biology Group, Institut de Recerca Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Pediatric Hematology and Oncology Department, Hospital Sant Joan de Déu Barcelona, University of Barcelona, Barcelona, Spain
| | - Mireia Camós
- Hematology Laboratory, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Barcelona, Spain
- Leukemia and Other Pediatric Hemopathies, Developmental Tumors Biology Group, Institut de Recerca Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Nerea Vega-García
- Hematology Laboratory, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Barcelona, Spain
- Leukemia and Other Pediatric Hemopathies, Developmental Tumors Biology Group, Institut de Recerca Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- *Correspondence: Nerea Vega-García,
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NK Cell Subpopulation Is Altered and the Expression of TLR1 and TLR9 Is Decreased in Patients with Acute Lymphoblastic Leukemia. JOURNAL OF ONCOLOGY 2021; 2021:5528378. [PMID: 34567117 PMCID: PMC8457960 DOI: 10.1155/2021/5528378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/28/2021] [Accepted: 08/05/2021] [Indexed: 11/20/2022]
Abstract
NK cells represent a heterogeneous subpopulation of lymphocytes of the innate immune system, which possess powerful antitumor activity. NK cells exhibit their function through a complex collection of receptors that act synergistically to recognize, regulate, or amplify the immune response. TLRs allow cells to detect PAMPs, MAMPs, or DAMPs, which are essential for the initiation of the immune response. Studies on the different subpopulations of NK cells and their expression profile of innate immune receptors in hematological cancers are limited. In this study, the specific subpopulations of NK cells in pediatric patients with acute lymphoblastic leukemia (ALL) and the repertoire and level of expression of TLRs in cytotoxic NK cells were assessed. The results suggested that pediatric patients with ALL exhibited a significant decrease in NK cells in peripheral blood and bone marrow, in addition to alterations in the distribution of the subpopulations of cells. Regulatory and cytotoxic NK cells were diminished, whereas dysfunctional phenotype was considerably increased. Cytotoxic NK cells from children with ALL expressed all 10 TLRs, and expression of TLR1 and TLR9 was decreased compared with the controls. Interestingly, cytotoxic NK cells exhibited a higher expression of TLR1 in the bone marrow than in the peripheral blood of patients with ALL. The present study is the first to show that TLR10 was expressed in the cytotoxic NK cells and the first to assess the profile and levels of the 10 known TLRs in cytotoxic NK cells from patients with ALL. The alterations in expression levels and cellular distribution may be involved in the immune response.
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Elashtokhy HEA, Elgohary HE, Eldeep BB, Gaber SM, Elbedewy TA. Retrospective study of Dana Farber Consortium Protocol in newly diagnosed Egyptian adolescents and young adults with acute lymphoblastic leukemia: Tanta experience. J Egypt Natl Canc Inst 2021; 33:9. [PMID: 33826046 DOI: 10.1186/s43046-021-00064-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 02/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intensive acute lymphoblastic leukemia (ALL) regimens in children improve the 5-year event-free survival (EFS) to reach ~ 90%. Adolescents and young adults (AYA) have EFS (30% to 45%). Young AYA ALL patients treated with pediatric chemotherapy protocols such as Dana Farber Consortium Protocol (DFCP) experience a better prognosis. This study aimed to assess the efficacy [EFS and overall survival (OS)] and the toxicity of DFCP in the treatment of Egyptian AYA with newly diagnosed ALL. A retrospective study was performed on 41 patients with newly diagnosed ALL (15 and 39 years) who were treated with DFCP. EFS and OS were estimated using the Kaplan-Meier method. RESULTS Thirty-eight patients (92.68%) achieved complete remission (CR). Eleven patients (26.83%) relapsed. Ten (24.39%) patients died. One, two, and three years of EFS were 75.61%, 72.91%, and 67.51% respectively. One, two, and three years OS were 85.3%, 77.26%, and 74.39% respectively. Neutropenia was the most common adverse event observed in 100% of patients. CONCLUSION DFCP can be considered as an effective ALL protocol for the AYA group of patients with good CR, EFS, and OS rates. DFCP seemed to be feasible in AYA despite the toxicities experienced.
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Affiliation(s)
| | - Heba E Elgohary
- Medical Oncology Department, Tanta Cancer Center, Tanta, Egypt
| | - Basant B Eldeep
- Medical Oncology Department, Tanta Cancer Center, Tanta, Egypt
| | - Sally M Gaber
- Medical Oncology Department, Tanta Cancer Center, Tanta, Egypt
| | - Tamer A Elbedewy
- Internal Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
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Helpful Criteria When Implementing NGS Panels in Childhood Lymphoblastic Leukemia. J Pers Med 2020; 10:jpm10040244. [PMID: 33255984 PMCID: PMC7711852 DOI: 10.3390/jpm10040244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/17/2020] [Accepted: 11/24/2020] [Indexed: 11/17/2022] Open
Abstract
The development of Next-Generation Sequencing (NGS) has provided useful diagnostic, prognostic, and therapeutic strategies for individualized management of B-cell precursor acute lymphoblastic leukemia (BCP-ALL) patients. Consequently, NGS is rapidly being established in clinical practice. However, the technology’s complexity, bioinformatics analysis, and the different available options difficult a broad consensus between different laboratories in its daily routine introduction. This collaborative study among Spanish centers was aimed to assess the feasibility, pros, and cons of our customized panel and other commercial alternatives of NGS-targeted approaches. The custom panel was tested in three different sequencing centers. We used the same samples to assess other commercial panels (OncomineTM Childhood Cancer Research Assay; Archer®FusionPlex® ALL, and Human Comprehensive Cancer Panel GeneRead Panel v2®). Overall, the panels showed a good performance in different centers and platforms, but each NGS approach presented some issues, as well as pros and cons. Moreover, a previous consensus on the analysis and reporting following international guidelines would be preferable to improve the concordance in results among centers. Our study shows the challenges posed by NGS methodology and the need to consider several aspects of the chosen NGS-targeted approach and reach a consensus before implementing it in daily practice.
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Armenian SH, Xu L, Cannavale KL, Wong FL, Bhatia S, Chao C. Cause-specific mortality in survivors of adolescent and young adult cancer. Cancer 2020; 126:2305-2316. [PMID: 32129881 DOI: 10.1002/cncr.32775] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 12/04/2019] [Accepted: 12/08/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Few studies have adequately addressed long-term survival (>20 years from diagnosis) among survivors of adolescent and young adult (AYA) cancers. METHODS In this retrospective, population-based cohort study in a US integrated health care system, the authors examined cause-specific mortality in 2-year survivors of AYA cancers (patients aged 15-39 years who were diagnosed between 1990 and 2012; N = 10,574) matched (by age, sex, and calendar year) to individuals without cancer (N = 136,683) to determine whether mortality rates changed over time. Incidence rate ratios (IRRs) for mortality were estimated using multivariable Poisson regression. A multivariable Cox model was used to examine predictors of cause-specific mortality among AYA cancer survivors. RESULTS Through December 31, 2014, 1352 deaths were observed among AYA cancer survivors, yielding an overall survival rate of 78.5% at 25 years after diagnosis. Overall, AYA cancer survivors were at 10.4-fold increased risk for death (95% CI, 9.7-fold to 11.2-fold increased risk for death) compared with the matched noncancer cohort, and this risk remained elevated at >20 years after diagnosis (IRR, 2.9; 95% CI, 2.0-4.3). The absolute excess risk for death from any cause was 12.7 per 1000 person-years (95% CI, 11.9-13.4 per 1000 person-years). Starting at 15 years after diagnosis, the incidence of second cancer-related mortality exceeded the rate of recurrence-related mortality, and similar trends were observed for deaths from other health-related conditions. The 8-year cumulative incidence of mortality declined over time (before 2000, 12.6%; 2000-2006, 10.1%; after 2006, 7.3%; P < .001), largely because of declines in recurrence-related mortality. Age, sex, race/ethnicity, cancer stage at diagnosis, and cancer treatment predicted cause-specific mortality. CONCLUSIONS The current data highlight the need for specialized, long-term follow-up care for AYA cancer survivors.
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Affiliation(s)
- Saro H Armenian
- Department of Population Sciences, City of Hope, Duarte, California
| | - Lanfang Xu
- MedHealth Statistical Consulting Inc, Solon, Ohio
| | - Kimberly L Cannavale
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - F Lennie Wong
- Department of Population Sciences, City of Hope, Duarte, California
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Chun Chao
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
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Trama A, Bernasconi A, McCabe MG, Guevara M, Gatta G, Botta L, Ries L, Bleyer A. Is the cancer survival improvement in European and American adolescent and young adults still lagging behind that in children? Pediatr Blood Cancer 2019; 66:e27407. [PMID: 30124231 DOI: 10.1002/pbc.27407] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 07/23/2018] [Accepted: 07/24/2018] [Indexed: 01/23/2023]
Abstract
Improvements during 1978 to 2006 in the 5-year survival rate of adolescents and young adults (AYAs, age 15-39) and children with cancers common to both age groups were evaluated for 1978 to 2006 in Europe and the USA. AYAs had absolute survival increases of 25% and 15% in Europe and the USA, respectively, but in both cases, AYA 5-year survival was, as of 2006, 4% lower than those in children. Acute lymphoblastic leukemia (ALL) explained most of the survival difference between AYAs and children on both the continents. In the USA, 20- to 39-year-olds with ALL have had less survival improvement than those in Europe.
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Affiliation(s)
- Annalisa Trama
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Alice Bernasconi
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Martin G McCabe
- Institute of Cancer Sciences, University of Manchester, Manchester, UK
| | - Marcela Guevara
- Public Health Institute of Navarra, IdiSNA, Pamplona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Gemma Gatta
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Laura Botta
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
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- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | | | - Archie Bleyer
- Oregon Health and Science University, Portland, Oregon.,University of Texas Medical School at Houston, Houston, Texas
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12
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Drozdov D, Bonaventure A, Nakata K, Suttorp M, Belot A. Temporal trends in the proportion of "cure" in children, adolescents, and young adults diagnosed with chronic myeloid leukemia in England: A population-based study. Pediatr Blood Cancer 2018; 65:e27422. [PMID: 30168243 DOI: 10.1002/pbc.27422] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 06/19/2018] [Accepted: 07/25/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Survival probability in children, adolescents, and young adults with chronic myeloid leukemia (CML) has dramatically improved during recent years. Tyrosine kinase inhibitors (TKI), targeted drugs developed for patients with CML, were introduced in 2001 in England. We here quantify the trends in the "cure" proportion according to the year of diagnosis. METHODS We included all children, adolescents, and young patients with CML (0 to 24 years) diagnosed in England during 1980 to 2005. We fitted mixture cure models to estimate the "cure" proportion and the median survival time among the "uncured" patients according to the year of diagnosis, adjusted for age at diagnosis. RESULTS The "cure" proportion increased dramatically between 1980 and 2005, from under 10% to over 80%, while conversely, the median survival time of "uncured" patients decreased slightly between 1980 and 1999, with the trend from 2000 being uncertain. CONCLUSIONS The striking improvement of the "cure" fraction in young patients with CML since the early 1980s is concomitant with improvement of treatment, especially the allogeneic hematopoietic stem-cell transplant and, later, the introduction of TKI. The trends over the last years (2000-2005) remain, however, uncertain and would benefit from further studies with more recent data and updated follow-up.
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Affiliation(s)
- Daniel Drozdov
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Division of Pediatric Oncology, Department of Pediatrics, Cantonal Hospital of Aarau, Aarau, Switzerland
| | - Audrey Bonaventure
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Kayo Nakata
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Cancer Control Centre, Osaka International Cancer Institute, Osaka, Japan
| | - Meinolf Suttorp
- Division of Pediatric Hematology-Oncology-Blood and Marrow Transplantation, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Aurélien Belot
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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13
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Zhang N, Shen SH, Wang NL, Li H, Yang JW, Shao JP, Jiang H, Tang JY. [Multicenter clinical trial of acute lymphoblastic leukemia in elder children and adolescents]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2018; 39:717-723. [PMID: 30369180 PMCID: PMC7342250 DOI: 10.3760/cma.j.issn.0253-2727.2018.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Indexed: 01/04/2023]
Abstract
Objective: To analyze the clinical characteristics and long-term outcomes with multicenter study for acute lymphoblastic leukemia (ALL) in children over 10 years old and adolescents. Method: Newly diagnosed ALL patients aged from 10 to 18 years old in three hospitals were included in the study from May 1(st) 2005 to April 30(th) 2015. They were received ALL-2005/2009 protocol following up to December 31(st) 2016. The clinical characteristics, outcomes and the prognostic analysis were evaluated between the two protocols. Results: Totally, 237 patients were involved in the study, 76 cases for ALL-2005 and 161 cases for ALL-2009 protocol. Complete remission (CR) after induction therapy was 94.5%. 64 (28.6%) patients relapsed with a median time of 14.5 months and 70 (29.5%) patients passed away during the following time. In long-term follow-up, the 5-year event-free survival (EFS) and 5-year overall survival (OS) of ALL patients were (63.1±3.3)% and (68.4±3.2)%. The 7-year EFS and OS were (61.0±3.5)% and (67.6±3.3)%.The 5-year EFS of intermediate risk group in ALL-2005 and ALL-2009 protocol were (73.6±6.1)% and (71.7±4.3)% with no difference (χ(2)=0.064, P=0.801). The 5-year EFS of high risk group in two protocols were (27.6±9.6)% and (33.9±9.3)%, showing no significant difference (χ(2)=0.296, P=0.586). Five years relapsed rate of two protocols were (33.8±5.7)% and (32.6±4.1)% with no difference (χ(2)=0.055, P=0.815). The mortalities were 36.8% and 29.8% separately (χ(2)=2.869, P=0.090). Univariate analysis indicated that age, male, risk, BCR/ABL translocation/t(9;22) and resistant to induction were risk prognostic factors in long-term survival (χ(2)=4.764, 4.796, 46.410, 9.560, 25.450; P=0.029, 0.029, <0.001, 0.049, <0.001). Cox multivariate analysis showed male, risk and resistant to induction were independent risk prognostic factors (RR=1.790, 2.727, 2.719; P=0.021, 0.000, 0.012). Conclusion: Protocol ALL-2009 enhanced the chemotherapy intensity in intermediate risk group with no benefit of survival. BCR-ABL fusion or t(9;22) translocation was still the risk factor of prognosis. TKI inhibitor used in these patients could improve survival. EFS rate was increased a little and death rate was decreased in ALL-2009 protocol with no significant lower relapsed rate comparing with ALL-2005 protocol.
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Affiliation(s)
- N Zhang
- Department of Hematology/Oncology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200040, China
| | | | | | | | | | | | - H Jiang
- Department of Hematology/Oncology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200040, China
| | - J Y Tang
- Department of Hematology/Oncology, Shanghai Children's Medical Center, Shanghai Jiao Tong University school of Medicine, Shanghai 200127, China
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14
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Draper GJ, Bithell JF, Bunch KJ, Kendall GM, Murphy MFG, Stiller CA. Childhood cancer research in Oxford II: The Childhood Cancer Research Group. Br J Cancer 2018; 119:763-770. [PMID: 30131553 PMCID: PMC6173767 DOI: 10.1038/s41416-018-0181-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 05/26/2018] [Accepted: 06/20/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND We summarise the work of the Childhood Cancer Research Group, particularly in relation to the UK National Registry of Childhood Tumours (NRCT). METHODS The Group was responsible for setting up and maintaining the NRCT. This registry was based on notifications from regional cancer registries, specialist children's tumour registries, paediatric oncologists and clinical trials organisers. For a large sample of cases, data on controls matched by date and place of birth were also collected. RESULTS Significant achievements of the Group include: studies of aetiology and of genetic epidemiology; proposals for, and participation in, international comparative studies of these diseases and on a classification system specifically for childhood cancer; the initial development of, and major contributions to, follow-up studies of the health of long-term survivors; the enhancement of cancer registration records by the addition of clinical data and of birth records. The Group made substantial contributions to the UK government's Committee on Medical Aspects of Radiation in the Environment. CONCLUSION An important part of the ethos of the Group was to work in collaboration with many other organisations and individuals, both nationally and internationally: many of the Group's achievements described here were the result of such collaborations.
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Affiliation(s)
- Gerald J Draper
- Department of Statistics, University of Oxford, 24-29 St Giles, Oxford, OX1 3LB, UK.
| | - John F Bithell
- Department of Statistics, University of Oxford, 24-29 St Giles, Oxford, OX1 3LB, UK
| | - Kathryn J Bunch
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK
| | - Gerald M Kendall
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK
| | - Michael F G Murphy
- Nuffield Department of Women's and Reproductive Health, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Charles A Stiller
- National Cancer Registration and Analysis Service, Public Health England, Chancellor Court, Oxford Business Park South, Oxford, OX4 2GX, UK
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15
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Corella Aznar EG, Ayerza Casas A, Carboné Bañeres A, Calvo Escribano MÁC, Labarta Aizpún JI, Samper Villagrasa P. Quality of life and chronic health conditions in childhood acute leukaemia survivors. Med Clin (Barc) 2018; 152:167-173. [PMID: 30017209 DOI: 10.1016/j.medcli.2018.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/15/2018] [Accepted: 05/17/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Survival of childhood acute lymphoblastic leukaemia involves an increasing risk of long-term morbidities. Due to the impact of cancer treatment and comorbidities, AL survivors may experience a decrease in their health-related quality of life. OBJECTIVE We aimed to describe the long-term comorbidities, related quality of life and their development predictors in these survivors. METHODS cross-sectional study of 54 survivors aged ≥18 and who have a survival rate of more than 10 years. Quality of life was assessed by personal interview using SF-36 questionnaire. RESULTS 53.7% of AL survivors developed more than one comorbidity (24.7% hypothyroidism; 20.3% obesity; 14.8% metabolic syndrome; 18.5% subclinical cardiac dysfunction); 20.3% of them were severe. 73.3% of high-risk leukaemias and 66.6% of patients treated with radiotherapy or stem cells transplantation reported long-term comorbidity, P<.05. Global quality of live score was: 86.3 (14) (classified as very good). Patients with high-risk acute leukaemia (83.2 vs. 89.5), severe long-term comorbidities (80.4 vs. 89.7) and females (81.8 vs. 89.9), reported worse quality of life, P<.05. Physical summary score was worse in: obese (80 vs. 92) and hypothyroid (84.9 vs. 92.4) and radiotherapy-treated survivors (82.3 vs. 87.5); mental summary was worse in survivors with hypogonadism (68.2 vs. 86.3) and trasplanted patients (77.2 vs. 83.1), P<.05. CONCLUSIONS Acute leukaemia survivors reported an increase prevalence of chronic comorbidities, related to cancer-treatment. Despite a decrease in scores for certain physical or mental items, global quality of life was very good in all acute leukaemia survivors, even better than compared with the general population.
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Affiliation(s)
| | | | - Ana Carboné Bañeres
- Oncohematología Pediátrica, Hospital Universitario Miguel Servet, Zaragoza, España
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16
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Vega-García N, Malatesta R, Estella C, Pérez-Jaume S, Esperanza-Cebollada E, Torrebadell M, Català A, Gassiot S, Berrueco R, Ruiz-Llobet A, Alonso-Saladrigues A, Mesegué M, Pont-Martí S, Rives S, Camós M. Paediatric patients with acute leukaemia andKMT2A (MLL)rearrangement show a distinctive expression pattern of histone deacetylases. Br J Haematol 2018; 182:542-553. [DOI: 10.1111/bjh.15436] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 04/26/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Nerea Vega-García
- Haematology Laboratory; Hospital Sant Joan de Déu Barcelona; University of Barcelona; Barcelona Spain
- Institut de Recerca Hospital Sant Joan de Déu Barcelona; Barcelona Spain
| | - Roberta Malatesta
- Haematology Laboratory; Hospital Sant Joan de Déu Barcelona; University of Barcelona; Barcelona Spain
- Institut de Recerca Hospital Sant Joan de Déu Barcelona; Barcelona Spain
| | - Camino Estella
- Haematology Laboratory; Hospital Sant Joan de Déu Barcelona; University of Barcelona; Barcelona Spain
- Institut de Recerca Hospital Sant Joan de Déu Barcelona; Barcelona Spain
| | - Sara Pérez-Jaume
- Developmental Tumor Biology Laboratory; Institut de Recerca Hospital Sant Joan de Déu Barcelona; Barcelona Spain
| | - Elena Esperanza-Cebollada
- Haematology Laboratory; Hospital Sant Joan de Déu Barcelona; University of Barcelona; Barcelona Spain
- Institut de Recerca Hospital Sant Joan de Déu Barcelona; Barcelona Spain
| | - Montserrat Torrebadell
- Haematology Laboratory; Hospital Sant Joan de Déu Barcelona; University of Barcelona; Barcelona Spain
- Institut de Recerca Hospital Sant Joan de Déu Barcelona; Barcelona Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER); Instituto de Salud Carlos III; Madrid Spain
| | - Albert Català
- Institut de Recerca Hospital Sant Joan de Déu Barcelona; Barcelona Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER); Instituto de Salud Carlos III; Madrid Spain
- Paediatric Haematology and Oncology Department; Hospital Sant Joan de Déu Barcelona; University of Barcelona; Barcelona Spain
| | - Susanna Gassiot
- Haematology Laboratory; Hospital Sant Joan de Déu Barcelona; University of Barcelona; Barcelona Spain
- Institut de Recerca Hospital Sant Joan de Déu Barcelona; Barcelona Spain
| | - Rubén Berrueco
- Institut de Recerca Hospital Sant Joan de Déu Barcelona; Barcelona Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER); Instituto de Salud Carlos III; Madrid Spain
- Paediatric Haematology and Oncology Department; Hospital Sant Joan de Déu Barcelona; University of Barcelona; Barcelona Spain
| | - Anna Ruiz-Llobet
- Institut de Recerca Hospital Sant Joan de Déu Barcelona; Barcelona Spain
- Paediatric Haematology and Oncology Department; Hospital Sant Joan de Déu Barcelona; University of Barcelona; Barcelona Spain
| | - Anna Alonso-Saladrigues
- Institut de Recerca Hospital Sant Joan de Déu Barcelona; Barcelona Spain
- Paediatric Haematology and Oncology Department; Hospital Sant Joan de Déu Barcelona; University of Barcelona; Barcelona Spain
| | - Montserrat Mesegué
- Institut de Recerca Hospital Sant Joan de Déu Barcelona; Barcelona Spain
- Paediatric Haematology and Oncology Department; Hospital Sant Joan de Déu Barcelona; University of Barcelona; Barcelona Spain
| | - Sandra Pont-Martí
- Haematology Laboratory; Hospital Sant Joan de Déu Barcelona; University of Barcelona; Barcelona Spain
- Institut de Recerca Hospital Sant Joan de Déu Barcelona; Barcelona Spain
| | - Susana Rives
- Institut de Recerca Hospital Sant Joan de Déu Barcelona; Barcelona Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER); Instituto de Salud Carlos III; Madrid Spain
- Paediatric Haematology and Oncology Department; Hospital Sant Joan de Déu Barcelona; University of Barcelona; Barcelona Spain
| | - Mireia Camós
- Haematology Laboratory; Hospital Sant Joan de Déu Barcelona; University of Barcelona; Barcelona Spain
- Institut de Recerca Hospital Sant Joan de Déu Barcelona; Barcelona Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER); Instituto de Salud Carlos III; Madrid Spain
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17
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Baughn LB, Meredith MM, Oseth L, Smolarek TA, Hirsch B. SH2B3 aberrations enriched in iAMP21 B lymphoblastic leukemia. Cancer Genet 2018; 226-227:30-35. [PMID: 30005852 DOI: 10.1016/j.cancergen.2018.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 05/07/2018] [Accepted: 05/19/2018] [Indexed: 11/18/2022]
Abstract
Acute lymphoblastic leukemia (ALL) represents the most common childhood malignancy. Although survival for pediatric B-ALL has approached 90%, variability in outcome among and within cytogenetically defined subgroups persists. While G-banding and fluorescence in situ hybridization (FISH) have been used to characterize leukemic clones, there is added value of chromosomal microarray and next generation sequencing in screening genome-wide for copy number aberrations, copy neutral loss of heterozygosity and nucleotide variations. Evaluation of novel genetic aberrations can provide information about the biologic mechanisms of cytogenetically defined subgroups associated with poor prognosis, explain heterogeneity in patient outcome and identify novel targets for therapeutic intervention. The high risk B-ALL intrachromosomal amplification of chromosome 21, (iAMP21), subtype is characterized by amplification of a region of chromosome 21 that typically encompasses the RUNX1 gene and is associated with poor prognosis. Analysis of chromosomal microarray and FISH data revealed that deletions of SH2B3, encoding a negative regulator of multiple tyrosine kinase and cytokine signaling pathways, are enriched among leukemias harboring iAMP21. Enrichment of SH2B3 aberrations in the iAMP21 subtype may indicate that loss of SH2B3 contributes to disease progression and raises the possibility that these leukemias may be sensitive to tyrosine kinase inhibitors.
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Affiliation(s)
- L B Baughn
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN, United States
| | - M M Meredith
- Department of Laboratory Medicine and Pathology and Masonic Cancer Center, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN, United States
| | - L Oseth
- Department of Laboratory Medicine and Pathology and Masonic Cancer Center, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN, United States
| | - T A Smolarek
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, TCHRF 1042, Cincinnati, OH, United States
| | - B Hirsch
- Department of Laboratory Medicine and Pathology and Masonic Cancer Center, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN, United States.
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Smith L, Glaser AW, Kinsey SE, Greenwood DC, Chilton L, Moorman AV, Feltbower RG. Long-term survival after childhood acute lymphoblastic leukaemia: population-based trends in cure and relapse by clinical characteristics. Br J Haematol 2018; 182:851-858. [DOI: 10.1111/bjh.15424] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/30/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Lesley Smith
- Clinical and Population Sciences Department; School of Medicine, University of Leeds; Leeds UK
- Leeds Institute for Data Analytics; University of Leeds; Leeds UK
| | - Adam W. Glaser
- Leeds Institute for Data Analytics; University of Leeds; Leeds UK
- Leeds Institute of Cancer and Pathology; School of Medicine, University of Leeds; Leeds UK
- Leeds General Infirmary; Leeds Teaching Hospitals NHS Trust; Leeds UK
| | - Sally E. Kinsey
- Leeds Institute of Cancer and Pathology; School of Medicine, University of Leeds; Leeds UK
- Leeds General Infirmary; Leeds Teaching Hospitals NHS Trust; Leeds UK
| | - Darren C. Greenwood
- Clinical and Population Sciences Department; School of Medicine, University of Leeds; Leeds UK
- Leeds Institute for Data Analytics; University of Leeds; Leeds UK
| | - Lucy Chilton
- Wolfson Childhood Cancer Research Centre; Northern Institute for Cancer Research; Newcastle University; Newcastle UK
| | - Anthony V. Moorman
- Wolfson Childhood Cancer Research Centre; Northern Institute for Cancer Research; Newcastle University; Newcastle UK
| | - Richard G. Feltbower
- Clinical and Population Sciences Department; School of Medicine, University of Leeds; Leeds UK
- Leeds Institute for Data Analytics; University of Leeds; Leeds UK
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19
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Allemani C, Matsuda T, Di Carlo V, Harewood R, Matz M, Nikšić M, Bonaventure A, Valkov M, Johnson CJ, Estève J, Ogunbiyi OJ, Azevedo E Silva G, Chen WQ, Eser S, Engholm G, Stiller CA, Monnereau A, Woods RR, Visser O, Lim GH, Aitken J, Weir HK, Coleman MP. Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet 2018; 391:1023-1075. [PMID: 29395269 PMCID: PMC5879496 DOI: 10.1016/s0140-6736(17)33326-3] [Citation(s) in RCA: 2896] [Impact Index Per Article: 482.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 12/05/2017] [Accepted: 12/07/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND In 2015, the second cycle of the CONCORD programme established global surveillance of cancer survival as a metric of the effectiveness of health systems and to inform global policy on cancer control. CONCORD-3 updates the worldwide surveillance of cancer survival to 2014. METHODS CONCORD-3 includes individual records for 37·5 million patients diagnosed with cancer during the 15-year period 2000-14. Data were provided by 322 population-based cancer registries in 71 countries and territories, 47 of which provided data with 100% population coverage. The study includes 18 cancers or groups of cancers: oesophagus, stomach, colon, rectum, liver, pancreas, lung, breast (women), cervix, ovary, prostate, and melanoma of the skin in adults, and brain tumours, leukaemias, and lymphomas in both adults and children. Standardised quality control procedures were applied; errors were rectified by the registry concerned. We estimated 5-year net survival. Estimates were age-standardised with the International Cancer Survival Standard weights. FINDINGS For most cancers, 5-year net survival remains among the highest in the world in the USA and Canada, in Australia and New Zealand, and in Finland, Iceland, Norway, and Sweden. For many cancers, Denmark is closing the survival gap with the other Nordic countries. Survival trends are generally increasing, even for some of the more lethal cancers: in some countries, survival has increased by up to 5% for cancers of the liver, pancreas, and lung. For women diagnosed during 2010-14, 5-year survival for breast cancer is now 89·5% in Australia and 90·2% in the USA, but international differences remain very wide, with levels as low as 66·1% in India. For gastrointestinal cancers, the highest levels of 5-year survival are seen in southeast Asia: in South Korea for cancers of the stomach (68·9%), colon (71·8%), and rectum (71·1%); in Japan for oesophageal cancer (36·0%); and in Taiwan for liver cancer (27·9%). By contrast, in the same world region, survival is generally lower than elsewhere for melanoma of the skin (59·9% in South Korea, 52·1% in Taiwan, and 49·6% in China), and for both lymphoid malignancies (52·5%, 50·5%, and 38·3%) and myeloid malignancies (45·9%, 33·4%, and 24·8%). For children diagnosed during 2010-14, 5-year survival for acute lymphoblastic leukaemia ranged from 49·8% in Ecuador to 95·2% in Finland. 5-year survival from brain tumours in children is higher than for adults but the global range is very wide (from 28·9% in Brazil to nearly 80% in Sweden and Denmark). INTERPRETATION The CONCORD programme enables timely comparisons of the overall effectiveness of health systems in providing care for 18 cancers that collectively represent 75% of all cancers diagnosed worldwide every year. It contributes to the evidence base for global policy on cancer control. Since 2017, the Organisation for Economic Co-operation and Development has used findings from the CONCORD programme as the official benchmark of cancer survival, among their indicators of the quality of health care in 48 countries worldwide. Governments must recognise population-based cancer registries as key policy tools that can be used to evaluate both the impact of cancer prevention strategies and the effectiveness of health systems for all patients diagnosed with cancer. FUNDING American Cancer Society; Centers for Disease Control and Prevention; Swiss Re; Swiss Cancer Research foundation; Swiss Cancer League; Institut National du Cancer; La Ligue Contre le Cancer; Rossy Family Foundation; US National Cancer Institute; and the Susan G Komen Foundation.
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Affiliation(s)
- Claudia Allemani
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
| | - Tomohiro Matsuda
- Population-based Cancer Registry Section, Division of Surveillance, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Veronica Di Carlo
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Rhea Harewood
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Melissa Matz
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Maja Nikšić
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Audrey Bonaventure
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Mikhail Valkov
- Department of Radiology, Radiotherapy and Oncology, Northern State Medical University, Arkhangelsk, Russia
| | | | - Jacques Estève
- Department of Biostatistics, Université Claude Bernard, Lyon, France
| | - Olufemi J Ogunbiyi
- Ibadan Cancer Registry, University City College Hospital, Ibadan, Dyo State, Nigeria
| | - Gulnar Azevedo E Silva
- Department of Epidemiology, Universidade do Estado do Rio de Janeiro, Maracanã, Rio de Janeiro, Brazil
| | - Wan-Qing Chen
- National Office for Cancer Prevention and Control and National Central Cancer Registry, National Cancer Center, Beijing, China
| | - Sultan Eser
- Department of Public Health, Balıkesir University, Balıkesir, Turkey
| | - Gerda Engholm
- Department of Documentation and Quality, Danish Cancer Society, Copenhagen, Denmark
| | - Charles A Stiller
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Alain Monnereau
- Registre des hémopathies malignes de la Gironde, Institut Bergonié, Bordeaux, France; French Network of Cancer Registries, Toulouse, France
| | - Ryan R Woods
- British Columbia Cancer Registry, BC Cancer Agency, Vancouver, BC, Canada
| | - Otto Visser
- Netherlands Cancer Registry Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands
| | - Gek Hsiang Lim
- National Registry of Diseases Office, Health Promotion Board, Singapore
| | - Joanne Aitken
- Cancer Council Queensland, Fortitude Valley, QLD, Australia
| | - Hannah K Weir
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michel P Coleman
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Wu J, Lu AD, Zhang LP. [Clinical characteristics and prognostic analysis of children and adolescents over 10 years of age with acute lymphoblastic leukemia]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2017; 19:614-619. [PMID: 28606225 PMCID: PMC7390288 DOI: 10.7499/j.issn.1008-8830.2017.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 01/30/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To explore the clinical characteristics and prognosis of children and adolescents over 10 years of age with acute lymphoblastic leukemia (ALL). METHODS A total of 86 newly diagnosed ALL children and adolescents over 10 years of age (62 cases of B-ALL and 24 cases of T-ALL) were enrolled. Clinical characteristics, therapeutic effect and prognostic factors were retrospectively analyzed. Event-free survival (EFS) and overall survival (OS) rates were estimated by the Kaplan-Meier method. Prognostic factors were evaluated by COX regression analysis. RESULTS Of 86 patients, 62 were in medium risk, and 24 in high risk. At diagnosis, 53 patients (62%) had hepatomegaly, 50 patients (58%) had splenomegaly, and 46 patients (54%) had lymphoadenopathy. Twenty-nine patients (34%) showed high leukocyte counts (≥50×109/L) at diagnosis. The karyotype analysis was performed on 78 patients. The percentage of hyperdiploidy was 19% (15 cases), and that of hypodiploidy was 5% (4 cases). Eleven patients (14%) had abnormalities of chromosome structure. Of them, one patient was Philadelphia chromosome-positive, and another patient had the t (1; 19) chromosomal translocation. Three patients (4%) were positive for TEL/AML1, 3 (4%) were positive for E2A/PBX1, 6 were positive for BCR/ABL (7%), and 4 (5%) were positive for SIL/TAL1. During 4 weeks of induction therapy, 85 patients (99%) achieved complete remission (CR). In 86 patients, the 5-year anticipated EFS and OS were (64±6)% and (75±5)% respectively. The 5-year EFS and OS in the medium risk group were significantly higher than those in the high risk group (P<0.05). The 5-year EFS in B-ALL patients was significantly higher than that in T-ALL patients (P<0.05). COX multivariate analysis showed that white blood counts at diagnosis and minimal residual disease (MRD) after induction therapy were independent prognostic factors. CONCLUSIONS Children and adolescents with ALL over 10 years of age often have clinical characteristics of unfavorable prognosis. White blood counts at diagnosis and MRD after induction therapy may be important factors for the long-term prognosis.
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Affiliation(s)
- Jun Wu
- Department of Pediatrics, People's Hospital, Peking University, Beijing 100044, China.
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Wu J, Lu AD, Zhang LP. [Clinical characteristics and prognostic analysis of children and adolescents over 10 years of age with acute lymphoblastic leukemia]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2017; 19:614-619. [PMID: 28606225 PMCID: PMC7390288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 01/30/2017] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To explore the clinical characteristics and prognosis of children and adolescents over 10 years of age with acute lymphoblastic leukemia (ALL). METHODS A total of 86 newly diagnosed ALL children and adolescents over 10 years of age (62 cases of B-ALL and 24 cases of T-ALL) were enrolled. Clinical characteristics, therapeutic effect and prognostic factors were retrospectively analyzed. Event-free survival (EFS) and overall survival (OS) rates were estimated by the Kaplan-Meier method. Prognostic factors were evaluated by COX regression analysis. RESULTS Of 86 patients, 62 were in medium risk, and 24 in high risk. At diagnosis, 53 patients (62%) had hepatomegaly, 50 patients (58%) had splenomegaly, and 46 patients (54%) had lymphoadenopathy. Twenty-nine patients (34%) showed high leukocyte counts (≥50×109/L) at diagnosis. The karyotype analysis was performed on 78 patients. The percentage of hyperdiploidy was 19% (15 cases), and that of hypodiploidy was 5% (4 cases). Eleven patients (14%) had abnormalities of chromosome structure. Of them, one patient was Philadelphia chromosome-positive, and another patient had the t (1; 19) chromosomal translocation. Three patients (4%) were positive for TEL/AML1, 3 (4%) were positive for E2A/PBX1, 6 were positive for BCR/ABL (7%), and 4 (5%) were positive for SIL/TAL1. During 4 weeks of induction therapy, 85 patients (99%) achieved complete remission (CR). In 86 patients, the 5-year anticipated EFS and OS were (64±6)% and (75±5)% respectively. The 5-year EFS and OS in the medium risk group were significantly higher than those in the high risk group (P<0.05). The 5-year EFS in B-ALL patients was significantly higher than that in T-ALL patients (P<0.05). COX multivariate analysis showed that white blood counts at diagnosis and minimal residual disease (MRD) after induction therapy were independent prognostic factors. CONCLUSIONS Children and adolescents with ALL over 10 years of age often have clinical characteristics of unfavorable prognosis. White blood counts at diagnosis and MRD after induction therapy may be important factors for the long-term prognosis.
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Affiliation(s)
- Jun Wu
- Department of Pediatrics, People's Hospital, Peking University, Beijing 100044, China.
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Marcos-Gragera R, Galceran J, Martos C, de Munain AL, Vicente-Raneda M, Navarro C, Quirós-Garcia JR, Sánchez MJ, Ardanaz E, Ramos M, Mateos A, Salmerón D, Felipe S, Peris-Bonet R. Incidence and survival time trends for Spanish children and adolescents with leukaemia from 1983 to 2007. Clin Transl Oncol 2017; 19:301-316. [PMID: 27447899 DOI: 10.1007/s12094-016-1531-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 07/12/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE We have analysed incidence and survival trends of children and adolescents with leukaemia registered in Spanish population-based cancer registries during the period 1983-2007. METHODS Childhood and adolescent leukaemia cases were drawn from the 11 Spanish population-based cancer registries. For survival, registries with data for the period 1991-2005 and follow-up until 31-12-2010 were included. Overall incidence trends were evaluated using joinpoint analysis. Observed survival rates were estimated using Kaplan-Meier, and trends were tested using the log-rank test. RESULTS Based on 2606 cases (2274 children and 332 adolescents), the overall age-adjusted incidence rate (ASRw) of leukaemia was 47.9 cases per million child-years in children and 23.8 in adolescents. The ASRw of leukaemia increased with an annual percentage change of 9.6 % (95 % CI: 2.2-17.6) until 1990 followed by a stabilisation of rates. In adolescents, incidence did not increase. Five-year survival increased from 66 % in 1991-1995 to 76 % in 2001-2005. By age, survival was dramatically lower in infants (0) and adolescents (15-19) than in the other age groups and no improvement was observed. In both children and adolescents, differences in 5-year survival rates among major subgroups of leukaemias were significant. CONCLUSIONS The increasing incidence trends observed in childhood leukaemias during the study period were confined to the beginning of the period. Remarkable improvements in survival have been observed in Spanish children with leukaemias. However, this improvement was not observed in infants and adolescents.
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Affiliation(s)
- R Marcos-Gragera
- Epidemiology Unit and Girona Cancer Registry (UERCG), Oncology Coordination Plan (PDO), Department of Health, Autonomous Government of Catalonia, Girona, Spain.
- Descriptive Epidemiology, Genetics and Cancer Prevention Group [Girona Biomedical Research Institute] IDIBGI, Catalan Institute of Oncology-Girona (ICO), Girona, Spain.
- Nursing Department, University of Girona (UdG), Girona, Spain.
| | - J Galceran
- Tarragona Cancer Registry, Foundation Society for Cancer Research and Prevention (FUNCA), Reus, Spain
- Pere Virgili Health Research Institute, Reus, Spain
- Rovira i Virgili University (URV), Reus, Spain
| | - C Martos
- Zaragoza Cancer Registry, Aragon Government, Saragossa, Spain
- Centre of Public Health Research-FISABIO, Valencia, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública CIBERESP), Madrid, Spain
| | - A L de Munain
- Basque Country Cancer Registry, Basque Government, Vitoria-Gasteiz, Spain
| | - M Vicente-Raneda
- Community Valenciana Childhood Cancer Registry, Public Health Directorate, Conselleria de Sanitat Universal i Salut Pública, Generalitat Valenciana, Valencia, Spain
| | - C Navarro
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública CIBERESP), Madrid, Spain
| | | | - M-J Sánchez
- Granada Cancer Registry, Andalusian School of Public Health, Granada, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública CIBERESP), Madrid, Spain
| | - E Ardanaz
- Navarre Cancer Registry, Navarre Public Health Institute, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública CIBERESP), Madrid, Spain
| | - M Ramos
- Mallorca Cancer Registry, Epidemiology Department, Directorate-General of Public Health and Participation, Palma de Mallorca, Spain
| | - A Mateos
- Albacete Cancer Registry, Health and Social Welfare Authority, Albacete, Spain
| | - D Salmerón
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública CIBERESP), Madrid, Spain
| | - S Felipe
- Spanish Childhood Cancer Registry (RETI-SEHOP), Spanish Society of Paediatric Haematology and Oncology, University of Valencia, Valencia, Spain
| | - R Peris-Bonet
- Spanish Childhood Cancer Registry (RETI-SEHOP), Spanish Society of Paediatric Haematology and Oncology, University of Valencia, Valencia, Spain
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Kowalski CJ, Hutchinson RJ, Mrdjenovich AJ. The Ethics of Clinical Care and the Ethics of Clinical Research: Yin and Yang. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2017; 42:7-32. [DOI: 10.1093/jmp/jhw032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Nakata-Yamada K, Inoue M, Ioka A, Ito Y, Tabuchi T, Miyashiro I, Masaie H, Ishikawa J, Hino M, Tsukuma H. Comparison of survival of adolescents and young adults with hematologic malignancies in Osaka, Japan. Leuk Lymphoma 2015; 57:1342-8. [PMID: 26695739 DOI: 10.3109/10428194.2015.1083562] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The survival gap between adolescents and young adults (AYAs) with hematological malignancies persists in many countries. To determine to what extent it does in Japan, we investigated survival and treatment regimens in 211 Japanese AYAs (15-29 years) in the Osaka Cancer Registry diagnosed during 2001-2005 with hematological malignancies, and compared adolescents (15-19 years) with young adults (20-29 years). AYAs with acute lymphoblastic leukemia (ALL) had a poor 5-year survival (44%), particularly young adults (29% vs. 64% in adolescents, p = 0.01). Additional investigation for patients with ALL revealed that only 19% of young adults were treated with pediatric treatment regimens compared with 45% of adolescents (p = 0.05). Our data indicate that we need to focus on young adults with ALL and to consider establishing appropriate cancer care system and guidelines for them in Japan.
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Affiliation(s)
- Kayo Nakata-Yamada
- a Center for Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases , Osaka , Japan
| | - Masami Inoue
- b Department of Hematology/Oncology , Osaka Medical Center and Research Institute for Maternal and Child Health , Osaka , Japan
| | - Akiko Ioka
- a Center for Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases , Osaka , Japan
| | - Yuri Ito
- a Center for Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases , Osaka , Japan
| | - Takahiro Tabuchi
- a Center for Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases , Osaka , Japan
| | - Isao Miyashiro
- a Center for Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases , Osaka , Japan
| | - Hiroaki Masaie
- c Department of Hematology/Oncology , Osaka Medical Center for Cancer and Cardiovascular Diseases , Osaka , Japan
| | - Jun Ishikawa
- c Department of Hematology/Oncology , Osaka Medical Center for Cancer and Cardiovascular Diseases , Osaka , Japan
| | - Masayuki Hino
- d Department of Hematology , Graduate School of Medicine, Osaka City University , Osaka , Japan
| | - Hideaki Tsukuma
- a Center for Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases , Osaka , Japan
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Oh HJ, Cheon KR, Jang HI, Cho JH, Jeong K, Baek HJ, Kook H. Comparison of Survival by Risk-stratified Therapy in Children and Adolescents with Acute Lymphoblastic Leukemia in a Single Institute. CLINICAL PEDIATRIC HEMATOLOGY-ONCOLOGY 2015. [DOI: 10.15264/cpho.2015.22.2.91] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Ha Jin Oh
- Department of Pediatrics, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Kyeong Ryeol Cheon
- Department of Pediatrics, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Hae In Jang
- Department of Pediatrics, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Joo Hyun Cho
- Department of Pediatrics, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
- Environmental Health Center for Childhood Leukemia and Cancer, Hwasun, Korea
| | - Kumhee Jeong
- Department of Pediatrics, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Hee Jo Baek
- Department of Pediatrics, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
- Environmental Health Center for Childhood Leukemia and Cancer, Hwasun, Korea
| | - Hoon Kook
- Department of Pediatrics, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
- Environmental Health Center for Childhood Leukemia and Cancer, Hwasun, Korea
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Jaime-Perez JC, Colunga-Pedraza PR, Gutiérrez-Aguirre CH, Pinzón-Uresti MA, Cantú-Rodríguez OG, Herrera-Garza JL, Gómez-Almaguer D. Efficacy of mitoxantrone as frontline anthracycline during induction therapy in adults with newly diagnosed acute lymphoblastic leukemia: a single-center experience. Leuk Lymphoma 2015; 56:2524-8. [PMID: 25629985 DOI: 10.3109/10428194.2015.1009058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Remission induction regimens for acute lymphoblastic leukemia (ALL) in adults induce complete remission (CR) in 60-90% and cure in 20-40%. A cohort study of newly diagnosed patients with ALL treated with mitoxantrone versus doxorubicin was conducted from 2005 to 2013. The primary endpoint was the proportion of CR. Eighty-five patients were included. Fifty-three received induction with doxorubicin and 32 with mitoxantrone. Median follow-up in the cohort was 40.2 months (range 2-95). Twenty-nine patients (90.6%) achieved CR in the mitoxantrone arm compared with 37 (69.8%) in the doxorubicin group (p = 0.032). There was no difference in death or relapse rate (p = 0.095 and 0.075), hematological recovery (p = 0.654), incidence of adverse events (p = 0.6), in-hospital days during induction (p = 0.456) or overall survival (p = 0.105). Induction toxicities were comparable. Mitoxantrone can be safely and effectively used as a frontline anthracycline in adults newly diagnosed with ALL.
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Affiliation(s)
- José Carlos Jaime-Perez
- a Department of Hematology , Internal Medicine Division, "Dr. José Eleuterio González" University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León , Monterrey , México
| | - Perla R Colunga-Pedraza
- a Department of Hematology , Internal Medicine Division, "Dr. José Eleuterio González" University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León , Monterrey , México
| | - César Homero Gutiérrez-Aguirre
- a Department of Hematology , Internal Medicine Division, "Dr. José Eleuterio González" University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León , Monterrey , México
| | - Mónica Andrea Pinzón-Uresti
- a Department of Hematology , Internal Medicine Division, "Dr. José Eleuterio González" University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León , Monterrey , México
| | - Olga G Cantú-Rodríguez
- a Department of Hematology , Internal Medicine Division, "Dr. José Eleuterio González" University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León , Monterrey , México
| | - José Luis Herrera-Garza
- a Department of Hematology , Internal Medicine Division, "Dr. José Eleuterio González" University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León , Monterrey , México
| | - David Gómez-Almaguer
- a Department of Hematology , Internal Medicine Division, "Dr. José Eleuterio González" University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León , Monterrey , México
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Bruzzi P, Predieri B, Corrias A, Marsciani A, Street ME, Rossidivita A, Paolucci P, Iughetti L. Final height and body mass index in adult survivors of childhood acute lymphoblastic leukemia treated without cranial radiotherapy: a retrospective longitudinal multicenter Italian study. BMC Pediatr 2014; 14:236. [PMID: 25245636 PMCID: PMC4194356 DOI: 10.1186/1471-2431-14-236] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 09/10/2014] [Indexed: 12/26/2022] Open
Abstract
Background Young adult survivors of childhood acute lymphoblastic leukemia (ALL) treated with protocols including cranial radiotherapy demonstrate a persistent weight gain and reduced final height. Published reports on the effects on growth of different oncologic therapies are conflicting and difficult to interpret because they combined children treated with both cranial irradiation and multi-agent chemotherapy. Our study investigated the effect of chemotherapy alone on body mass index (BMI) and on growth at the achievement of final height in a homogeneous cohort of Italian childhood ALL survivors. Methods We retrospectively studied 162 Caucasian patients treated on the Italian Association of Pediatric Hematology and Oncology protocols without radiotherapy between 1989 and 2000 at five Italian centers with 107 inclusions (58 males). Height- and BMI-standard deviation score (SDS) were collected at diagnosis of ALL, at the end of treatment and at the achievement of final height. Changes in height SDS and BMI SDS with time were analyzed using dependent sample Student's t-test. Results A significant reduction of height-SDS was documented during treatment in both genders. This reduction of height-SDS was not followed by an appropriate catch-up growth, despite the achievement of a mean final height within the normal range. At diagnosis females showed a lower mean BMI-SDS than males. During treatment, in the whole population, BMI-SDS increased significantly. After it, while males lost BMI-SDS, females showed its persistent increase. Conclusions Survivors of childhood ALL generally seemed to achieve a normal final height with a BMI within the normal range. These parameters appeared to be only minimally affected by chemotherapy. Nevertheless, height catch-up growth was not completed after chemotherapy in both genders and all patients experienced an increase of BMI-SDS during chemotherapy that only females seemed to conserve until the achievement of final height.
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Affiliation(s)
| | | | | | | | | | | | | | - Lorenzo Iughetti
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena & Reggio Emilia, Via del Pozzo, 71, 41124 Modena, Italy.
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Lipshultz SE, Franco VI, Sallan SE, Adamson PC, K. Steiner R, Swain SM, Gligorov J, Minotti G. Dexrazoxane for reducing anthracycline-related cardiotoxicity in children with cancer: An update of the evidence. PROGRESS IN PEDIATRIC CARDIOLOGY 2014. [DOI: 10.1016/j.ppedcard.2014.09.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Treatment of adolescent and young adults with acute lymphoblastic leukemia. Mediterr J Hematol Infect Dis 2014; 6:e2014052. [PMID: 25045460 PMCID: PMC4103503 DOI: 10.4084/mjhid.2014.052] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 06/30/2014] [Indexed: 12/27/2022] Open
Abstract
The primary objective of this review was to update and discuss the current concepts and the results of the treatment of acute lymphoblastic leukemia (ALL) in adolescents and young adults (AYA). After a brief consideration of the epidemiologic and clinicobiologic characteristics of ALL in the AYA population, the main retrospective comparative studies stating the superiority of pediatric over adult-based protocols were reviewed. The most important prospective studies in young adults using pediatric inspired or pediatric unmodified protocols were also reviewed emphasizing their feasibility at least up to the age of 40 yr and their promising results, with event-free survival rates of 60–65% or greater. Results of trials from pediatric groups have shown that the unfavourable prognosis of adolescents is no more adequate. The majority of the older adolescents with ALL can be cured with risk-adjusted and minimal residual disease-guided intensive chemotherapy, without stem cell transplantation. However, some specific subgroups, which are more frequent in adolescents than in children (e.g., early pre-T, iAMP21, and BCR-ABL-like), deserve particular attention. In summary, the advances in treatment of ALL in adolescents have been translated to young adults, and that explains the significant improvement in survival of these patients in recent years.
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Woo JS, Alberti MO, Tirado CA. Childhood B-acute lymphoblastic leukemia: a genetic update. Exp Hematol Oncol 2014; 3:16. [PMID: 24949228 PMCID: PMC4063430 DOI: 10.1186/2162-3619-3-16] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 06/03/2014] [Indexed: 01/06/2023] Open
Abstract
In the pediatric population, B-acute lymphoblastic leukemia (B-ALL) is the most prevalent childhood hematological malignancy, as well as the leading cause of childhood cancer-related mortality. Advances in cytogenetics utilizing array-based technologies and next-generation sequencing (NGS) techniques have revealed exciting insights into the genetic basis of this disease, with the hopes of developing individualized treatment plans for affected children. In this comprehensive review, we discuss our current understanding of childhood (pediatric) B-ALL and highlight the most recent genetic advances and their therapeutic implications.
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Affiliation(s)
- Jennifer S Woo
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, 1010 Veteran Ave, 2nd Floor, room 2212 F, Los Angeles, CA 90024, USA
| | - Michael O Alberti
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, 1010 Veteran Ave, 2nd Floor, room 2212 F, Los Angeles, CA 90024, USA
| | - Carlos A Tirado
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, 1010 Veteran Ave, 2nd Floor, room 2212 F, Los Angeles, CA 90024, USA
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Site-specific proportion cured models applied to cancer registry data. Cancer Causes Control 2014; 25:365-73. [PMID: 24442714 DOI: 10.1007/s10552-014-0337-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 01/08/2014] [Indexed: 12/25/2022]
Abstract
PURPOSE Proportion-cured models were applied to evaluate their applicability on data from a relatively small cancer registry and to assess the up-to-date survival level of major cancer types in Tyrol, Austria. METHODS In total, the 25 most common types of cancer were analyzed with mixture cure models using the period approach for estimation of the proportion cured and median survival time of the fatal cases. RESULTS For several of the cancer types, no estimates could be obtained. The models converged for 14 sites among females and for 15 among males. The highest estimate of the proportion cured was found for cervix cancer (74.0 %; 95 % CI 64.4-83.6) and the lowest for male pancreas cancer (4.6 %; 95 % CI 0.2-9.0). The highest median survival of the uncured was 2.7 years (95 % CI 1.2-6.0) for male larynx cancer and the lowest 0.3 years (95 % CI 0.1-0.6) for male acute myeloblastic leukemia (AML). CONCLUSIONS The estimates seem reliable for stomach, colon, rectum, pancreas, lung, cervix, ovary, central nervous system/brain and AML cancer and among men also for head/neck, esophagus, liver and kidney cancer. Altogether, it is demonstrated that even data from a regional cancer registry covering a rather small region can be utilized to derive up-to-date survival estimates of various cancer types, enabling monitoring of the development and changes in cancer treatment. Moreover, potentially this methodology is advantageously employable in any situation where the number of cancer cases is limited.
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Place AE, Frederick NN, Sallan SE. Therapeutic approaches to haematological malignancies in adolescents and young adults. Br J Haematol 2013; 164:3-14. [PMID: 24007213 DOI: 10.1111/bjh.12556] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 08/14/2013] [Indexed: 11/28/2022]
Abstract
Tremendous strides have been made in improving the outcomes of haematological malignancies (HM) over the last three decades, but adolescents and young adult (AYA) patients have not benefitted equally compared to younger and older patients. Excellent outcomes in Hodgkin lymphoma have allowed tailoring of highly effective regimens that limit the incidence of late effects. Early successes in paediatric acute lymphoblastic leukaemia set the stage for a series of studies in young adults utilizing a paediatric-type treatment strategy. These studies have determined that AYAs benefit from paediatric-type chemotherapy regimens. Despite the increased incidence of acute myeloid leukaemia and non-Hodgkin lymphoma in the AYA age group, optimal strategies for these patients have not been systematically pursued. There is renewed interest in improving HM outcomes in AYA patients and this will rely on the development of clinical trials that specifically target these patients. Understanding and addressing the unique psychosocial challenges of this population will be critical in supporting this endeavor.
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Affiliation(s)
- Andrew E Place
- Dana-Farber Cancer Institute, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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Zwaan CM, Sposto R. Cure trends in acute lymphoblastic leukemia: is it time for a revised concept of cure? Haematologica 2013; 98:655-6. [PMID: 23633537 DOI: 10.3324/haematol.2013.084269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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