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Hou SM, Shao JB, Li H, Zhang N, Zhu JS, Wang D, Fu P. [Prognostic analysis of childhood T-lymphoblastic lymphoma treated with leukemia regimen]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2024; 26:469-475. [PMID: 38802906 DOI: 10.7499/j.issn.1008-8830.2311060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
OBJECTIVES To investigate the prognosis of childhood T-lymphoblastic lymphoma (T-LBL) treated with acute lymphoblastic leukemia (ALL) regimen and related influencing factors. METHODS A retrospective analysis was performed for the prognostic characteristics of 29 children with T-LBL who were treated with ALL regimen (ALL-2009 or CCCG-ALL-2015 regimen) from May 2010 to May 2022. RESULTS The 29 children with T-LBL had a 5-year overall survival (OS) rate of 84%±7% and an event-free survival (EFS) rate of 81%±8%. The children with B systemic symptoms (unexplained fever >38°C for more than 3 days; night sweats; weight loss >10% within 6 months) at initial diagnosis had a lower 5-year EFS rate compared to the children without B symptoms (P<0.05). The children with platelet count >400×109/L and involvement of both mediastinum and lymph nodes at initial diagnosis had lower 5-year OS rates (P<0.05). There were no significant differences in 5-year OS and EFS rates between the children treated with CCCG-ALL-2015 regimen and those treated with ALL-2009 regimen (P>0.05). Compared with the ALL-2009 regimen, the CCCG-ALL-2015 regimen reduced the frequency of high-dose methotrexate chemotherapy and the incidence rate of severe infections (P<0.05). CONCLUSIONS The ALL regimen is safe and effective in children with T-LBL. Children with B systemic symptoms, platelet count >400×109/L, and involvement of both mediastinum and lymph nodes at initial diagnosis tend to have a poor prognosis. Reduction in the frequency of high-dose methotrexate chemotherapy can reduce the incidence rate of severe infections, but it does not affect prognosis.
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Affiliation(s)
- Shu-Min Hou
- Department of Hematology/Oncology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200040, China
| | - Jing-Bo Shao
- Department of Hematology/Oncology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200040, China
| | - Hong Li
- Department of Hematology/Oncology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200040, China
| | - Na Zhang
- Department of Hematology/Oncology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200040, China
| | - Jia-Shi Zhu
- Department of Hematology/Oncology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200040, China
| | - Dan Wang
- Department of Hematology/Oncology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200040, China
| | - Pan Fu
- Department of Hematology/Oncology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200040, China
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Xu M, Wu S, Wang Y, Zhao Y, Wang X, Wei C, Liu X, Hao F, Hu C. Association between high-dose methotrexate-induced toxicity and polymorphisms within methotrexate pathway genes in acute lymphoblastic leukemia. Front Pharmacol 2022; 13:1003812. [PMID: 36532750 PMCID: PMC9748425 DOI: 10.3389/fphar.2022.1003812] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/21/2022] [Indexed: 09/22/2023] Open
Abstract
Methotrexate (MTX) is a folic acid antagonist, the mechanism of action is to inhibit DNA synthesis, repair and cell proliferation by decreasing the activities of several folate-dependent enzymes. It is widely used as a chemotherapy drug for children and adults with malignant tumors. High-dose methotrexate (HD-MTX) is an effective treatment for extramedullary infiltration and systemic consolidation in children with acute lymphoblastic leukemia (ALL). However, significant toxicity results in most patients treated with HD-MTX, which limits its use. HD-MTX-induced toxicity is heterogeneous, and this heterogeneity may be related to gene polymorphisms in related enzymes of the MTX intracellular metabolic pathway. To gain a deeper understanding of the differences in toxicity induced by HD-MTX in individuals, the present review examines the correlation between HD-MTX-induced toxicity and the gene polymorphisms of related enzymes in the MTX metabolic pathway in ALL. In this review, we conclude that only the association of SLCO1B1 and ARID5B gene polymorphisms with plasma levels of MTX and MTX-related toxicity is clearly described. These results suggest that SLCO1B1 and ARID5B gene polymorphisms should be evaluated before HD-MTX treatment. In addition, considering factors such as age and race, the other exact predictor of MTX induced toxicity in ALL needs to be further determined.
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Affiliation(s)
- Meng Xu
- College of Laboratory Medicine, Jilin Medical University, Jilin, China
- School of Laboratory Medicine, Beihua University, Jilin, China
| | - Shuangshuang Wu
- Department of Pediatric Hematology, The First Hospital of Jilin University, Changchun, China
- National Engineering Laboratory for AIDS Vaccine, School of Life Sciences, Jilin University, Changchun, China
| | - Yue Wang
- Department of Pediatric Hematology, The First Hospital of Jilin University, Changchun, China
| | - Yundong Zhao
- School of Laboratory Medicine, Beihua University, Jilin, China
| | - Ximin Wang
- Jilin Drug Inspection Center, Changchun, China
| | - Changhong Wei
- Department of Hematology, The Linyi Central Hospital, Linyi, China
| | - Xueying Liu
- College of Laboratory Medicine, Jilin Medical University, Jilin, China
- School of Laboratory Medicine, Beihua University, Jilin, China
| | - Feng Hao
- College of Laboratory Medicine, Jilin Medical University, Jilin, China
| | - Cheng Hu
- College of Laboratory Medicine, Jilin Medical University, Jilin, China
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Jain A, Singh C, Dhawan R, Jindal N, Mohindra R, Lad D, Prakash G, Khadwal A, Suri V, Bhalla A, Kumari S, Varma N, John MJ, Mahapatra M, Malhotra P. How to Use a Prioritised Approach for Treating Hematological Disorders During the COVID-19 Pandemic in India? Indian J Hematol Blood Transfus 2020; 36:605-615. [PMID: 32837051 PMCID: PMC7274942 DOI: 10.1007/s12288-020-01300-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 06/02/2020] [Indexed: 12/29/2022] Open
Abstract
The current pandemic coronavirus, SARS-CoV-2, is known to cause severe infection (COVID-19) in patients with comorbidities, particularly cancer or an immunosuppressed state. Most healthcare systems in the country are likely to be overwhelmed soon if the pandemic moves to a stage of community transmission. Currently, limited evidence is available for managing patients with hematological disorders during the COVID-19 pandemic. The current review summarises the possible challenges clinicians are likely to face, key considerations to guide decision making, and possible solutions to the anticipated challenges. Disease specific recommendations and possible guidance for decision making have been suggested for most hematologic diseases that are feasible in our health setup. It is not meant to replace individual clinical judgment, but to provide a template to formulate local policies.
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Affiliation(s)
- Arihant Jain
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
| | - Charanpreet Singh
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
| | - Rishi Dhawan
- Department of Hematology, All India Institute of Medical Education and Research, New Delhi, India
| | - Nishant Jindal
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
| | - Ritin Mohindra
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
| | - Deepesh Lad
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
| | - Gaurav Prakash
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
| | - Alka Khadwal
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
| | - Vikas Suri
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
| | - Ashish Bhalla
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
| | - Savita Kumari
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
| | - Neelam Varma
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - M Joseph John
- Department of Clinical Haematology, Christian Medical College and Hospital, Ludhiana, India
| | - Manoranjan Mahapatra
- Department of Hematology, All India Institute of Medical Education and Research, New Delhi, India
| | - Pankaj Malhotra
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
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Jastaniah W. Improving survival outcomes of childhood acute lymphoblastic leukemia: A 25-year experience from a single center in Saudi Arabia. Pediatr Blood Cancer 2019; 66:e27782. [PMID: 31184419 DOI: 10.1002/pbc.27782] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 04/10/2019] [Accepted: 04/15/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The development of cancer programs in developing countries to meet the standards observed in high-income developed countries is not well documented. METHODS An analysis of patient care of children with acute lymphoblastic leukemia (ALL) at the Princess Noorah Oncology Center over 25 years was performed. A number of improvements were introduced over time including optimizing the cancer care delivery culture, improving access to care, optimizing supportive care, and refining diagnostic and therapeutic capabilities. Outcomes were evaluated over three time periods (period 1, 1989-2000; period 2, 2001-2007; and period 3, 2008-2014). These findings were compared with results of collaborative clinical trials (CCT). RESULTS Of the 686 patients treated, the five-year overall survival (OS) rate improved from 74% ± 2.7% in period 1 to 89.5% ± 2.3% in period 3 (P < 0.0001). Among all patients, the five-year cumulative incidence of death decreased from 26% in period 1 to 10.5% in period 3 (P < 0.0001). This decrease was mainly due to reduction in the incidence of death from disease (P < 0.00001). In contrast, significant improvement in T-cell ALL survival outcomes (P < 0.0001) was observed overtime (from period 1 to period 3) as a result of significant reduction in both toxic deaths (P = 0.005) and disease-related deaths (P = 0.001). CONCLUSIONS Survival outcomes in Saudi Arabia have improved with five-year OS rate now approaching 90%. However, further population-based research is needed to understand variance in outcomes from those reported by CCT groups.
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Affiliation(s)
- Wasil Jastaniah
- College of Medicine, Department of Pediatrics, Umm AlQura University, Makkah, Saudi Arabia.,Princess Noorah Oncology Center, Ministry of National Guard-Health Affairs, Jeddah, Saudi Arabia
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Jastaniah W, Elimam N, Abdalla K, AlAzmi AA, Elgaml AM, Alkassar A, Daghistani M, Felimban S. Early vs. late MRD response- and risk-based treatment intensification of childhood acute lymphoblastic leukemia: a prospective pilot study from Saudi Arabia. Exp Hematol Oncol 2018; 7:29. [PMID: 30479872 PMCID: PMC6245521 DOI: 10.1186/s40164-018-0121-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 11/14/2018] [Indexed: 12/20/2022] Open
Abstract
Background Refinement of risk-based treatment stratification by minimal residual disease (MRD) at different time points has improved outcomes of childhood acute lymphoblastic leukemia (ALL). In this prospective study we evaluated effects of such stratification, including intensification of therapy based on response assessment at day-15 and MRD at day-29 of induction to test if treatment intensification would improve outcomes. Methods 241 patients, 1-14 years old, newly diagnosed with ALL, were recruited and stratified by risk and MRD response into three treatment Arms (A, B, or C). Arm A was modified from COG AALL0331, B from AALL0232, and C from AALL0232 and AALL0434. Assignments were according to NCI risk, phenotype, rapid vs. slow early response (SER), steroid pretreatment, MLL rearrangement (MLLR), CNS3, and testicular involvement. Patients on Arm A had treatment intensified early based on day-15 marrow results or late based on end-of-induction MRD. Results 5-year OS, EFS, and CIR were 89.5% ± 4.0%, 87.6% ± 4.3%, and 7.1% ± 3.5%. No significant difference was found by B- vs. T cell phenotype. 5-year OS, EFS, and CIR for B-cell ALL were 90.5% ± 2.4%, 88.7% ± 2.6%, and 6.4% ± 2.0%. Outcomes for patients with t(1;19)/TCF3-PBX1 and MLLR were significantly (p ≤ 0.05) worse than for other patients. MRD level at end-of-induction associated with outcomes, but association with a specific MRD value at end-of-induction varied significantly by NCI-risk group. Late treatment intensification based on end-of-induction MRD significantly improved survival outcomes for NCI-SR patients, however, patients with NCI-HR and positive MRD at end-of-induction had significantly inferior outcomes despite intensification. MRD transitions between day-15 and day-29 of induction associated with differences for OS and EFS. Conclusions Arm switching to a more intensive protocol had mixed results. Assigning patients by end-of-induction MRD-risk alone did not reflect response kinetics of the different NCI-risk groups. Although late treatment intensification improved outcomes of NCI-SR patients with positive MRD at end-of-induction, further refinement is needed to improve outcomes of NCI-HR with SER. Integration of NCI-risk group with specific MRD value and time point allows more refined treatment stratification.Trial Registration Protocols were approved by King Abdullah International Medical Research Center and Ethics Review Committee RC08053J.
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Affiliation(s)
- Wasil Jastaniah
- 1Department of Pediatrics, Faculty of Medicine, Umm AlQura University, Makkah, Saudi Arabia.,Princess Noorah Oncology Center, King Saud Bin Abdulaziz University for Health Sciences and King Abdulaziz Medical City, Ministry of National Guard Health Affairs, P.O. Box 9515, Jeddah, 21423 Saudi Arabia
| | - Naglla Elimam
- Princess Noorah Oncology Center, King Saud Bin Abdulaziz University for Health Sciences and King Abdulaziz Medical City, Ministry of National Guard Health Affairs, P.O. Box 9515, Jeddah, 21423 Saudi Arabia
| | - Khalid Abdalla
- Princess Noorah Oncology Center, King Saud Bin Abdulaziz University for Health Sciences and King Abdulaziz Medical City, Ministry of National Guard Health Affairs, P.O. Box 9515, Jeddah, 21423 Saudi Arabia
| | - Aeshah A AlAzmi
- Department of Pharmaceutical Care, Clinical Pharmacy, Pediatric Hematology/Oncology, King Saud Bin Abdulaziz University for Health Sciences and King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Aml M Elgaml
- Princess Noorah Oncology Center, King Saud Bin Abdulaziz University for Health Sciences and King Abdulaziz Medical City, Ministry of National Guard Health Affairs, P.O. Box 9515, Jeddah, 21423 Saudi Arabia
| | - Ahmad Alkassar
- 4Department of Pathology and Laboratory Medicine, Flow Cytometry Unit, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Mustafa Daghistani
- 5Department of Pathology and Laboratory Medicine, Cytogenetics and Molecular Cytogenetics Unit, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia.,College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences and King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Sami Felimban
- Princess Noorah Oncology Center, King Saud Bin Abdulaziz University for Health Sciences and King Abdulaziz Medical City, Ministry of National Guard Health Affairs, P.O. Box 9515, Jeddah, 21423 Saudi Arabia
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