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Rujkijyanont P, Inaba H. Diagnostic and treatment strategies for pediatric acute lymphoblastic leukemia in low- and middle-income countries. Leukemia 2024:10.1038/s41375-024-02277-9. [PMID: 38762553 DOI: 10.1038/s41375-024-02277-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 05/20/2024]
Abstract
The survival rate of children and adolescents with acute lymphoblastic leukemia (ALL), the most common pediatric cancer, has improved significantly in high-income countries (HICs), serving as an excellent example of how humans can overcome catastrophic diseases. However, the outcomes in children with ALL in low- and middle-income countries (LMICs), where approximately 80% of the global population live, are suboptimal because of limited access to diagnostic procedures, chemotherapeutic agents, supportive care, and financial assistance. Although the implementation of therapeutic strategies in resource-limited countries could theoretically follow the same path of improvement as modeled in HICs, intensification of chemotherapy may simply result in increased toxicities. With the advent of genetic diagnosis, molecular targeted therapy, and immunotherapy, the management of ALL is changing dramatically in HICs. Multidisciplinary collaborations between institutions in LMICs and HICs will provide access to strategies that are suitable for institutions in LMICs, enabling them to minimize toxicities while improving outcomes. This article summarizes important aspects of the diagnosis and treatment of pediatric ALL that were mostly developed in HICs but that can be realistically implemented by institutions in countries with limited resources through resource-adapted multidisciplinary collaborations.
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Affiliation(s)
- Piya Rujkijyanont
- Division of Hematology-Oncology, Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Hiroto Inaba
- Leukemia/Lymphoma Division, Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA.
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2
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Hayashi H, Makimoto A, Yuza Y. Treatment of Pediatric Acute Lymphoblastic Leukemia: A Historical Perspective. Cancers (Basel) 2024; 16:723. [PMID: 38398113 PMCID: PMC10887299 DOI: 10.3390/cancers16040723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
Acute lymphoblastic leukemia (ALL) is the most common disease in pediatric oncology. The history of developmental therapeutics for ALL began in the 1960s with the repetition of "unreliable" medical interventions against this lethal disease. By the 1990s, the development of multi-agent chemotherapy and various types of supportive care rendered ALL treatable. Highly sophisticated, molecular, diagnostic techniques have enabled highly accurate prediction of the relapse risk, and the application of risk-adapted treatments has increased the survival rate in the standard-risk group to nearly 100% in most European nations and North America. Incorporation of state-of-the-art, molecularly targeted agents and novel treatments, including cell and immunotherapy, is further improving outcomes even in the high-risk group. On the other hand, the financial burden of treating children with ALL has increased, imperiling the availability of these diagnostic and treatment strategies to patients in low- and middle-income countries (LMICs). The fundamental treatment strategy, consisting of corticosteroid and classical cytotoxic therapy, has achieved fairly good outcomes and should be feasible in LMICs as well. The present review will discuss the history of developmental therapeutics for childhood ALL in various countries through an extensive literature review with the aim of proposing a model for a treatment backbone for pediatric ALL. The discussion will hopefully benefit LMICs and be useful as a base for future clinical trials of novel treatments.
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Affiliation(s)
- Hiroshi Hayashi
- Department of Hematology/Oncology, Tokyo Metropolitan Children’s Medical Center, 2-8-29 Musashidai, Fuchu 183-8561, Tokyo, Japan; (A.M.); (Y.Y.)
| | - Atsushi Makimoto
- Department of Hematology/Oncology, Tokyo Metropolitan Children’s Medical Center, 2-8-29 Musashidai, Fuchu 183-8561, Tokyo, Japan; (A.M.); (Y.Y.)
- Department of Laboratory Medicine, Tokyo Metropolitan Children’s Medical Center, 2-8-29 Musashidai, Fuchu 183-8561, Tokyo, Japan
| | - Yuki Yuza
- Department of Hematology/Oncology, Tokyo Metropolitan Children’s Medical Center, 2-8-29 Musashidai, Fuchu 183-8561, Tokyo, Japan; (A.M.); (Y.Y.)
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3
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Suryaprakash S, Inaba H. Acute Lymphoblastic Leukemia with Central Nervous System Involvement-Challenges in Management. Indian J Pediatr 2024; 91:59-66. [PMID: 37507619 DOI: 10.1007/s12098-023-04731-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/09/2023] [Indexed: 07/30/2023]
Abstract
The survival of patients with acute lymphoblastic leukemia (ALL) has dramatically improved during the last six decades. This improvement is secondary to improved diagnostics, risk stratification of treatment by biological features and response to treatment, improved supportive care, and the introduction of new treatment modalities such as immunotherapy and molecular targeted therapy. However, many questions remain concerning the involvement of the central nervous system (CNS) in leukemia, including ones pertaining to the risk factors for CNS involvement and relapse, the optimal treatment strategy to prevent relapse, and the role of newer therapies. This review discusses these questions by addressing the diagnosis of CNS leukemia, the current clinical trial data for treatment regimens with CNS activity, and issues specific to treatment in low- and middle-income countries (LMICs).
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Affiliation(s)
- Shruthi Suryaprakash
- Department of Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 260, Memphis, TN, 38105, USA
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Hiroto Inaba
- Department of Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 260, Memphis, TN, 38105, USA.
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA.
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4
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Pieters R, Mullighan CG, Hunger SP. Advancing Diagnostics and Therapy to Reach Universal Cure in Childhood ALL. J Clin Oncol 2023; 41:5579-5591. [PMID: 37820294 PMCID: PMC10730082 DOI: 10.1200/jco.23.01286] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/24/2023] [Accepted: 08/10/2023] [Indexed: 10/13/2023] Open
Abstract
Systemic combination chemotherapy and intrathecal chemotherapy markedly increased the survival rate of children with ALL. In the past two decades, the use of minimal (measurable) residual disease (MRD) measurements early in therapy improved risk group stratification with subsequent treatment intensifications for patients at high risk of relapse, and enabled a reduction of treatment for low-risk patients. The recent development of more sensitive MRD technologies may further affect risk stratification. Molecular genetic profiling has led to the discovery of many new subtypes and their driver genetic alterations. This increased our understanding of the biological basis of ALL, improved risk classification, and enabled implementation of precision medicine. In the past decade, immunotherapies, including bispecific antibodies, antibody-drug conjugates, and cellular therapies directed against surface proteins, led to more effective and less toxic therapies, replacing intensive chemotherapy courses and allogeneic stem-cell transplantation in patients with relapsed and refractory ALL, and are now being tested in newly diagnosed patients. It has taken 50-60 years to increase the cure rate in childhood ALL from 0% to 90% by stepwise improvements in chemotherapy. This review provides an overview of how the developments over the past 10-15 years mentioned above have significantly changed the diagnostic and treatment approach in ALL, and discusses how the integrated use of molecular and immunotherapeutic insights will very likely direct efforts to cure those children with ALL who are not cured today, and improve the quality of life for survivors who should have decades of life ahead. Future efforts must focus on making effective, yet very expensive, new technologies and therapies available to children with ALL worldwide.
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Affiliation(s)
- Rob Pieters
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Charles G. Mullighan
- Department of Pathology and Hematological Malignancies Program, Comprehensive Cancer Center, St Jude Children's Research Hospital, Memphis, TN
| | - Stephen P. Hunger
- Division of Oncology, Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
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Zhang S, Tu Y, Lai H, Chen H, Tu H, Li J. PPARG, GNG12, and CD19 are potential independent predictors of central nerve recurrence in childhood acute lymphoblastic leukemia. Hematology 2023; 28:2182169. [PMID: 36861936 DOI: 10.1080/16078454.2023.2182169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
OBJECTIVE To identify biomarkers that can predict the recurrence of the central nervous system (CNS) in children with acute lymphoblastic leukemia (ALL). MATERIALS AND METHODS The transcriptome and clinical data of ALL in children were downloaded from the TARGET database. Transcriptome data were analyzed by bioinformatics method to identify core (hub) genes and establish a risk assessment model. Univariate Cox analysis was performed on each clinical data, and multivariate Cox regression analysis was performed on the obtained results and risk score. The children ALL phase I samples from TARGET database were used for validation. RESULTS Univariate multivariate Cox analysis of 10 hub genes identified showed that PPARG (HR = 0.78, 95%CI = 0.67-0.91, p = 0.007), CD19 (HR = 1.15, 95%CI = 1.05-1.26, p = 0.003) and GNG12 (HR = 1.25, 95%CI = 1.04-1.51, p = 0.017) had statistical differences. The risk score was statistically significant in univariate (HR = 3.06, 95%CI = 1.30-7.19, p = 0.011) and multivariate (HR = 1.81, 95%CI = 1.16-2.32, p = 0.046) Cox regression analysis. The survival analysis results of the high and low-risk groups were different when the validation dataset was substituted into the model (p = 0.018). Then, we constructed a Nomogram which had a concordance index of survival prediction of 0.791(95%CI= 0.779-0.803). In addition, the CNS involvement grading status at first diagnosis CNS3 vs. CNS1 (HR = 5.74, 95%CI = 2.01-16.4, p = 0.001), T cell vs B cell (HR = 1.63, 95% CI = 1.06-2.49, p = 0.026) were also statistically significant. CONCLUSIONS PPARG, GNG12, and CD19 may be predictors of CNS relapse in childhood ALL.
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Affiliation(s)
- Shan Zhang
- The Key Laboratory of Hematology of Jiangxi Province, The Department of Hematology, The Second Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China.,Graduate School of Medicine, Nanchang University, Nanchang, People's Republic of China
| | - Yansong Tu
- Faculty of Environment, University of Waterloo, Waterloo, Canada
| | - Hurong Lai
- The Key Laboratory of Hematology of Jiangxi Province, The Department of Hematology, The Second Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China.,Graduate School of Medicine, Nanchang University, Nanchang, People's Republic of China
| | - Huijun Chen
- The Key Laboratory of Hematology of Jiangxi Province, The Department of Hematology, The Second Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Huaijun Tu
- Graduate School of Medicine, Nanchang University, Nanchang, People's Republic of China.,The Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Jian Li
- The Key Laboratory of Hematology of Jiangxi Province, The Department of Hematology, The Second Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China.,Graduate School of Medicine, Nanchang University, Nanchang, People's Republic of China
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Zhao R, Liu YY, Wu SS, Liu XC, Tian XX, Zhou KS. [Long-term results of modified POG 9404 protocol for 4 adolescents with T-cell lymphoblastic leukemia/lymphoma]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2023; 44:255-257. [PMID: 37356990 PMCID: PMC10119719 DOI: 10.3760/cma.j.issn.0253-2727.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Indexed: 06/27/2023]
Affiliation(s)
- R Zhao
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou 450003, China
| | - Y Y Liu
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou 450003, China
| | - S S Wu
- Department of Hematology, Zhumadian Central Hospital, Zhumadian 463000, China
| | - X C Liu
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou 450003, China
| | - X X Tian
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou 450003, China
| | - K S Zhou
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou 450003, China
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Thastrup M, Duguid A, Mirian C, Schmiegelow K, Halsey C. Central nervous system involvement in childhood acute lymphoblastic leukemia: challenges and solutions. Leukemia 2022; 36:2751-2768. [PMID: 36266325 PMCID: PMC9712093 DOI: 10.1038/s41375-022-01714-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 09/17/2022] [Accepted: 09/22/2022] [Indexed: 11/10/2022]
Abstract
Delivery of effective anti-leukemic agents to the central nervous system (CNS) is considered essential for cure of childhood acute lymphoblastic leukemia. Current CNS-directed therapy comprises systemic therapy with good CNS-penetration accompanied by repeated intrathecal treatments up to 26 times over 2-3 years. This approach prevents most CNS relapses, but is associated with significant short and long term neurotoxicity. Despite this burdensome therapy, there have been no new drugs licensed for CNS-leukemia since the 1960s, when very limited anti-leukemic agents were available and there was no mechanistic understanding of leukemia survival in the CNS. Another major barrier to improved treatment is that we cannot accurately identify children at risk of CNS relapse, or monitor response to treatment, due to a lack of sensitive biomarkers. A paradigm shift in treating the CNS is needed. The challenges are clear - we cannot measure CNS leukemic load, trials have been unable to establish the most effective CNS treatment regimens, and non-toxic approaches for relapsed, refractory, or intolerant patients are lacking. In this review we discuss these challenges and highlight research advances aiming to provide solutions. Unlocking the potential of risk-adapted non-toxic CNS-directed therapy requires; (1) discovery of robust diagnostic, prognostic and response biomarkers for CNS-leukemia, (2) identification of novel therapeutic targets combined with associated investment in drug development and early-phase trials and (3) engineering of immunotherapies to overcome the unique challenges of the CNS microenvironment. Fortunately, research into CNS-ALL is now making progress in addressing these unmet needs: biomarkers, such as CSF-flow cytometry, are now being tested in prospective trials, novel drugs are being tested in Phase I/II trials, and immunotherapies are increasingly available to patients with CNS relapses. The future is hopeful for improved management of the CNS over the next decade.
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Affiliation(s)
- Maria Thastrup
- Department of Pediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Alasdair Duguid
- Centre for Regenerative Medicine, University of Edinburgh, Edinburgh, UK
| | - Christian Mirian
- Department of Pediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Protein Research, Proteomics Program, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christina Halsey
- Wolfson Wohl Cancer Research Centre, School of Cancer Sciences, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
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Schilstra CE, McCleary K, Fardell JE, Donoghoe MW, McCormack E, Kotecha RS, Lourenco RDA, Ramachandran S, Cockcroft R, Conyers R, Cross S, Dalla-Pozza L, Downie P, Revesz T, Osborn M, Alvaro F, Wakefield CE, Marshall GM, Mateos MK, Trahair TN. Prospective longitudinal evaluation of treatment-related toxicity and health-related quality of life during the first year of treatment for pediatric acute lymphoblastic leukemia. BMC Cancer 2022; 22:985. [PMID: 36109702 PMCID: PMC9479356 DOI: 10.1186/s12885-022-10072-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 09/09/2022] [Indexed: 01/19/2023] Open
Abstract
Background Pediatric acute lymphoblastic leukemia (ALL) therapy is accompanied by treatment-related toxicities (TRTs) and impaired quality of life. In Australia and New Zealand, children with ALL are treated with either Children’s Oncology Group (COG) or international Berlin-Frankfurt-Munster (iBFM) Study Group-based therapy. We conducted a prospective registry study to document symptomatic TRTs (venous thrombosis, neurotoxicity, pancreatitis and bone toxicity), compare TRT outcomes to retrospective TRT data, and measure the impact of TRTs on children’s general and cancer-related health-related quality of life (HRQoL) and parents’ emotional well-being. Methods Parents of children with newly diagnosed ALL were invited to participate in the ASSET (Acute Lymphoblastic Leukaemia Subtypes and Side Effects from Treatment) study and a prospective, longitudinal HRQoL study. TRTs were reported prospectively and families completed questionnaires for general (Healthy Utility Index Mark 3) and cancer specific (Pediatric Quality of Life Inventory (PedsQL)-Cancer Module) health related quality of life as well the Emotion Thermometer to assess emotional well-being. Results Beginning in 2016, 260 pediatric patients with ALL were enrolled on the TRT registry with a median age at diagnosis of 59 months (range 1–213 months), 144 males (55.4%), majority with Pre-B cell immunophenotype, n = 226 (86.9%), 173 patients (66.5%) treated according to COG platform with relatively equal distribution across risk classification sub-groups. From 2018, 79 families participated in the HRQoL study through the first year of treatment. There were 74 TRT recorded, reflecting a 28.5% risk of developing a TRT. Individual TRT incidence was consistent with previous studies, being 7.7% for symptomatic VTE, 11.9% neurotoxicity, 5.4% bone toxicity and 5.0% pancreatitis. Children’s HRQoL was significantly lower than population norms throughout the first year of treatment. An improvement in general HRQoL, measured by the HUI3, contrasted with the lack of improvement in cancer-related HRQoL measured by the PedsQL Cancer Module over the first 12 months. There were no persisting differences in the HRQoL impact of COG compared to iBFM therapy. Conclusions It is feasible to prospectively monitor TRT incidence and longitudinal HRQoL impacts during ALL therapy. Early phases of ALL therapy, regardless of treatment platform, result in prolonged reductions in cancer-related HRQoL. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-10072-x.
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Zhuang Y, Wu K, Zhu X, Cai J, Hu S, Gao J, Jiang H, Zhai X, Tian X, Fang Y, Jin R, Hu Q, Jiang H, Wang N, Sun L, Leung WK, Yang M, Pan K, Wu X, Liang C, Shen S, Yu J, Ju X. Reduced Dose Intensity of Daunorubicin During Remission Induction for Low-Risk Patients With Acute Lymphoblastic Leukemia: A Retrospective Cohort Study of the Chinese Children’s Cancer Group. Front Oncol 2022; 12:911567. [PMID: 35747795 PMCID: PMC9209708 DOI: 10.3389/fonc.2022.911567] [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: 04/02/2022] [Accepted: 05/12/2022] [Indexed: 11/30/2022] Open
Abstract
It is urgently necessary to reduce the adverse effects of chemotherapy while maintaining their cure high rates for children with acute lymphoblastic leukemia (ALL). The present study aimed to determine whether the dose intensity of daunorubicin during the remission-induction phase could be reduced for low-risk patients with ALL. A total of 2396 eligible patients, who participated in CCCG-ALL-2015 study and were provisionally assigned to the low-risk group, were included and divided into single-dose group and double-dose group according to the dosage of daunorubicin during the remission-induction phase. For patients with ETV6-RUNX1 positive ALL or hyperdiploidy ALL, there were no significant differences in outcomes between the two groups. For other patients, the 5-year event-free survival rate was significantly better and the 5-year cumulative risk of any relapse was significantly lower in the double-dose group compared with the single-dose group. Both the 5-year overall survival rate and the risk of early deaths were not significantly different between the two groups. Our results suggested that only B-lineage ALL patients with ETV6-RUNX1 positivity or hyperdiploidy who achieved an early negative minimal residual disease status were suitable candidates for dosage reduction of daunorubicin during the remission-induction phase.
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Affiliation(s)
- Yong Zhuang
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, China
| | - Kefei Wu
- National Children’s Medical Center, Department of Hematology/Oncology, Key Laboratory of Pediatric Hematology and Oncology of China Ministry of Health, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaofan Zhu
- State Key Laboratory of Experimental Hematology and Division of Pediatric Blood Diseases Center, Institute of Hematology and Blood Diseases Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Tianjin, China
| | - Jiaoyang Cai
- National Children’s Medical Center, Department of Hematology/Oncology, Key Laboratory of Pediatric Hematology and Oncology of China Ministry of Health, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shaoyan Hu
- Department of Hematology/Oncology, Children’s Hospital of Soochow University, Suzhou, China
| | - Ju Gao
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Disease of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Hua Jiang
- Department of Hematology/Oncology, Guangzhou Women and Children’s Medical Center, Guangzhou, China
| | - Xiaowen Zhai
- Department of Hematology/Oncology, Children’s Hospital of Fudan University, Shanghai, China
| | - Xin Tian
- Department of Hematology/Oncology, Kunming Children’s Hospital, Kunming, China
| | - Yongjun Fang
- Department of Hematology/Oncology, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Runming Jin
- Department of Pediatrics, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qun Hu
- Department of Pediatrics, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hui Jiang
- Department of Hematology/Oncology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ningling Wang
- Department of Pediatrics, Anhui Medical University Second Affiliated Hospital, Hefei, China
| | - Lirong Sun
- Department of Pediatrics, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wing Kwan Leung
- Department of Pediatrics, Hong Kong Children’s Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Minghua Yang
- Department of Pediatrics, Xiangya Hospital Central South University, Changsha, China
| | - Kaili Pan
- Department of Hematology/Oncology, Xi’an Northwest Women and Children Hospital, Xi’an, China
| | - Xuedong Wu
- Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Changda Liang
- Department of Hematology/Oncology, Jiangxi Provincial Children’s Hospital, Nanchang, China
| | - Shuhong Shen
- National Children’s Medical Center, Department of Hematology/Oncology, Key Laboratory of Pediatric Hematology and Oncology of China Ministry of Health, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Yu
- Department of Hematology/Oncology, Chongqing Medical University Affiliated Children’s Hospital, Chongqing, China
- *Correspondence: Jie Yu, ; Xiuli Ju,
| | - Xiuli Ju
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, China
- *Correspondence: Jie Yu, ; Xiuli Ju,
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McNeer JL, Schmiegelow K. Management of CNS Disease in Pediatric Acute Lymphoblastic Leukemia. Curr Hematol Malig Rep 2022; 17:1-14. [PMID: 35025035 DOI: 10.1007/s11899-021-00640-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW The treatment of acute lymphoblastic leukemia (ALL) is one of the success stories of pediatric oncology, but challenges and questions remain, including the optimal approach to the treatment of central nervous system (CNS) leukemia. It is unclear why some children with ALL develop CNS leukemia and others do not, and there remains debate regarding optimal regimens for prophylaxis, upfront treatment, and the treatment of CNS relapses. These topics are especially important since both cranial radiation therapy (CRT) and intensive intrathecal therapy carry risks of both short- and long-term adverse effects. In this review, we aim to identify areas of ongoing debate on this topic, review the biology of CNS leukemia, and summarize clinical trial data that address some of these questions. RECENT FINDINGS Both retrospective and meta-analyses have demonstrated that few patients with ALL benefit from CRT as a component of CNS-directed treatment for de novo disease, allowing cooperative groups to greatly limit the number of patients undergoing CRT as part of their initial ALL regimens. More recent efforts are focusing on how best to assay for low levels of CNS disease at the time of diagnosis, as well as the biological drivers that may result in CNS leukemia in certain patients. Progress remains to be made in the identification and treatment of CNS leukemia in pediatric ALL. Advancements have occurred to limit the number of children undergoing CRT, but much has yet to be learned to better understand the biology of and risk factors for CNS leukemia, and novel approaches are required to approach CNS relapse of ALL.
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Affiliation(s)
- Jennifer L McNeer
- Section of Pediatric Hematology/Oncology/Stem Cell Transplant, University of Chicago Comer Children's Hospital, 5841 S. Maryland Ave, MC 4060, Chicago, IL, 60637, USA.
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
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Central Nervous System Prophylaxis and Treatment in Acute Leukemias. Curr Treat Options Oncol 2022; 23:1829-1844. [PMID: 36510037 PMCID: PMC9767998 DOI: 10.1007/s11864-022-01032-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2022] [Indexed: 12/15/2022]
Abstract
OPINION STATEMENT Improvements in systemic therapy in the treatment of acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) have improved patient outcomes and reduced the incidence of CNS relapse. However, management of patients with CNS disease remains challenging, and relapses in the CNS can be difficult to salvage. In addition to treatment with CNS-penetrant systemic therapy (high-dose methotrexate and cytarabine), intrathecal prophylaxis is indicated in all patients with ALL, however is not uniformly administered in patients with AML without high-risk features. There is a limited role for radiation treatment in CNS prophylaxis; however, radiation should be considered for consolidative treatment in patients with CNS disease, or as an option for palliation of symptoms. Re-examining the role of established treatment paradigms and investigating the role of radiation as bridging therapy in the era of cellular therapy, particularly in chemotherapy refractory patients, is warranted.
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ESFAHANI H, SEDIGHI I, SAHRAEI M, SEIF RABIE MA, HOSSEINI F. Comparison of Chloral Hydrate Solution, Hydroxyzine Syrup, and Lidocaine/Prilocaine Cream as Premedication for Lumbar Puncture in Children: A Double-Blind Study. IRANIAN JOURNAL OF CHILD NEUROLOGY 2022; 16:29-34. [PMID: 36204436 PMCID: PMC9531204 DOI: 10.22037/ijcn.v16i3.28605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/07/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aimed to compare the clinical effectiveness of oral hydroxyzine and chloral hydrate to topical lidocaine/prilocaine 2.5% cream as premedication in pediatric leukemia patients. MATERIALS & METHODS This double-blind clinical trial study was conducted on 70 leukemic and nonleukemic patients aged 3-11 years. The patients were divided into four groups. In group A, chloral hydrate solution was given to 18 patients. In group B, hydroxyzine syrup was used for 18 patients. In group C, chloral hydrate solution and lidocaine/prilocaine cream were used for 17 patients. In group D, hydroxyzine syrup and lidocaine/prilocaine cream were used for 17 patients. These groups were assessed and judged based on the visual analog scale (VAS). The side effects of the drugs were also recorded. RESULTS In this study, 54.3% (n=38) and 45.7% (n=32) of the cases were female and male, respectively. Furthermore, 77%, 7.2%, and 15.8% of the cases were reported with acute lymphocytic leukemia, acute myeloid leukemia, and infectious disease, respectively. The VAS results showed no difference in these four groups. Nontraumatic lumbar puncture (LP) (red blood cell<50) was observed in 97.1% of the cases. CONCLUSION Although premedications for LP with hydroxyzine syrup and chloral hydrate solution were not statistically effective in pain relief, they increased patient and parent satisfaction. Moreover, adding lidocaine/prilocaine cream does not improve the effectiveness of the drugs.
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Affiliation(s)
- Hossein ESFAHANI
- Pediatric Hematologist/Oncologist, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Iraj SEDIGHI
- Pediatric Infectious Disease, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Maryam SAHRAEI
- Pediatric Resident, Hamadan University of Medical Sciences, Hamadan, Iran
| | | | - Firozeh HOSSEINI
- Pediatric Neurologist, Hamadan University of Medical Sciences, Hamadan, Iran
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13
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Gaynon PS, Parekh C. A new standard of care for childhood T-cell acute lymphoblastic leukemia? Pediatr Blood Cancer 2021; 68:e29238. [PMID: 34302711 DOI: 10.1002/pbc.29238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/15/2021] [Accepted: 06/25/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Paul S Gaynon
- Children's Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, California, USA.,University of Southern California, Los Angeles, California, USA
| | - Chintan Parekh
- Children's Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, California, USA.,University of Southern California, Los Angeles, California, USA
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14
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van der Plas E, Noakes TLS, Butcher DT, Weksberg R, Galin-Corini L, Wanstall EA, Te P, Hopf L, Guger S, Hitzler J, Schachar RJ, Ito S, Nieman BJ. Cognitive and behavioral risk factors for low quality of life in survivors of childhood acute lymphoblastic leukemia. Pediatr Res 2021; 90:419-426. [PMID: 33203967 PMCID: PMC9014848 DOI: 10.1038/s41390-020-01230-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/25/2020] [Accepted: 10/03/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND With high survival rates for pediatric acute lymphoblastic leukemia (ALL), long-term quality of life is a prominent consideration in treatment. We concurrently evaluated cognition, behavior, and quality of life in child and adolescent ALL survivors and determined associations between them. METHODS The sample included 83 controls (mean age: 12.5 years) and 71 ALL survivors (mean age: 11.9 years, mean age at diagnosis: 3.8 years). Participants completed measures of general intellectual abilities, math achievement, and fine motor skills. Parents and teachers completed a survey assessing child participants' cognitive, behavioral, and emotional function. Parents additionally completed a survey about their child's quality of life. RESULTS Survivors had lower scores on measures of working memory, processing speed, timed math, and fine motor skills (effect size 0.5-1, p < 0.001). Parents identified more problems with executive function and learning in survivors than controls (effect size > 0.7, p < 0.001), and indicated a lower quality of life in all categories evaluated (effect size > 0.7, p < 10-4). Reduced quality of life was associated with lower math achievement scores and with inattention and executive function problems. CONCLUSIONS ALL survivors experience diffuse cognitive, behavioral, and motor impairments, which are associated with reduced quality of life. These findings underscore the need to address these challenges in ALL survivors. IMPACT Compared with cancer-free peers, parents of childhood acute lymphoblastic leukemia survivors treated with chemotherapy only reported reduced quality of life. Math difficulties and behavioral problems increased the risk for reduced quality of life. Reduced quality of life is associated with mild cognitive and behavioral difficulties, suggesting that even relatively mild impairments have broad implications for ALL survivors. Screening and early intervention targeting cognitive and behavioral function may enhance quality of life for ALL survivors.
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Affiliation(s)
- Ellen van der Plas
- Department of Psychiatry, University of Iowa Hospital & Clinics, Iowa City, IA
| | - T. Leigh Spencer Noakes
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, ON, Canada,Translational Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Darci T. Butcher
- Genetics & Genome Biology, Hospital for Sick Children Research Institute, Toronto, ON, Canada,Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Rosanna Weksberg
- Genetics & Genome Biology, Hospital for Sick Children Research Institute, Toronto, ON, Canada,Clinical and Metabolic Genetics, Hospital for Sick Children Research Institute, Toronto, ON, Canada,Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | | | - Elizabeth A. Wanstall
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Psychology, York University, Toronto, ON, Canada
| | - Patrick Te
- Translational Medicine, Hospital for Sick Children, Toronto, ON, Canada,Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, ON, Canada
| | - Laura Hopf
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sharon Guger
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Johann Hitzler
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Developmental and Stem Cell Biology, Hospital for Sick Children, Toronto, ON, Canada,Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | - Russell J. Schachar
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada,Psychiatry Research, Hospital for Sick Children, Toronto, ON, Canada
| | - Shinya Ito
- Translational Medicine, Hospital for Sick Children, Toronto, ON, Canada,Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, ON, Canada,Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Brian J. Nieman
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, ON, Canada,Translational Medicine, Hospital for Sick Children, Toronto, ON, Canada,Ontario Institute for Cancer Research, Toronto, ON, Canada,Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada,Corresponding Author: Brian J. Nieman, Hospital for Sick Children, Centre for Phenogenomics25 Orde Street, Toronto, ON, Canada, M5T 3H7; 416-813-7654 ext. 309555;
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15
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Kim H, You S, Park Y, Choi JY, Ma Y, Hong KT, Koh KN, Yun S, Lee KH, Shin HY, Lee S, Yoo KH, Im HJ, Kang HJ, Kim JH. Interplay between IL6 and CRIM1 in thiopurine intolerance due to hematological toxicity in leukemic patients with wild-type NUDT15 and TPMT. Sci Rep 2021; 11:9676. [PMID: 33958640 PMCID: PMC8102572 DOI: 10.1038/s41598-021-88963-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 04/13/2021] [Indexed: 11/14/2022] Open
Abstract
NUDT15 and TPMT variants are strong genetic determinants of thiopurine-induced hematological toxicity. Despite the impact of homozygous CRIM1 on thiopurine toxicity, several patients with wild-type NUDT15, TPMT, and CRIM1 experience thiopurine toxicity, therapeutic failure, and relapse of acute lymphoblastic leukemia (ALL). Novel pharmacogenetic interactions associated with thiopurine intolerance from hematological toxicities were investigated using whole-exome sequencing for last-cycle 6-mercaptopurine dose intensity percentages (DIP) tolerated by pediatric ALL patients (N = 320). IL6 rs13306435 carriers (N = 19) exhibited significantly lower DIP (48.0 ± 27.3%) than non-carriers (N = 209, 69.9 ± 29.0%; p = 0.0016 and 0.0028 by t test and multiple linear regression, respectively). Among 19 carriers, 7 with both heterozygous IL6 rs13306435 and CRIM1 rs3821169 showed significantly decreased DIP (24.7 ± 8.9%) than those with IL6 (N = 12, 61.6 ± 25.1%) or CRIM1 (N = 94, 68.1 ± 28.4%) variants. IL6 and CRIM1 variants showed marked inter-ethnic variability. Four-gene-interplay models revealed the best odds ratio (8.06) and potential population impact [relative risk (5.73), population attributable fraction (58%), number needed to treat (3.67), and number needed to genotype (12.50)]. Interplay between IL6 rs13306435 and CRIM1 rs3821169 was suggested as an independent and/or additive genetic determinant of thiopurine intolerance beyond NUDT15 and TPMT in pediatric ALL.
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Affiliation(s)
- Hyery Kim
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Seungwon You
- Seoul National University Biomedical Informatics (SNUBI), Division of Biomedical Informatics, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Yoomi Park
- Seoul National University Biomedical Informatics (SNUBI), Division of Biomedical Informatics, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Jung Yoon Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, 03080, Korea.,Seoul National University Cancer Research Institute, Seoul, Korea
| | - Youngeun Ma
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul, Korea
| | - Kyung Tak Hong
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, 03080, Korea
| | - Kyung-Nam Koh
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Sunmin Yun
- Seoul National University Biomedical Informatics (SNUBI), Division of Biomedical Informatics, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Kye Hwa Lee
- Seoul National University Biomedical Informatics (SNUBI), Division of Biomedical Informatics, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.,Department of Information Medicine, Asan Medical Center and University of Ulsan College of Medicine, Seoul, 05505, Korea
| | - Hee Young Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, 03080, Korea
| | - Suehyun Lee
- Seoul National University Biomedical Informatics (SNUBI), Division of Biomedical Informatics, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.,Department of Biomedical Informatics, College of Medicine, Konyang University, Taejon, Korea
| | - Keon Hee Yoo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ho Joon Im
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
| | - Hyoung Jin Kang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, 03080, Korea. .,Seoul National University Cancer Research Institute, Seoul, Korea.
| | - Ju Han Kim
- Seoul National University Biomedical Informatics (SNUBI), Division of Biomedical Informatics, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
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16
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Mateos MK, Marshall GM, Barbaro PM, Quinn MC, George C, Mayoh C, Sutton R, Revesz T, Giles JE, Barbaric D, Alvaro F, Mechinaud F, Catchpoole D, Lawson JA, Chenevix-Trench G, MacGregor S, Kotecha RS, Dalla-Pozza L, Trahair TN. Methotrexate-related central neurotoxicity: clinical characteristics, risk factors and genome-wide association study in children treated for acute lymphoblastic leukemia. Haematologica 2021; 107:635-643. [PMID: 33567813 PMCID: PMC8883571 DOI: 10.3324/haematol.2020.268565] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Indexed: 11/09/2022] Open
Abstract
Symptomatic methotrexate-related central neurotoxicity, 'MTX neurotoxicity', is a severe toxicity experienced during acute lymphoblastic leukemia (ALL) therapy with potential long-term neurologic complications. Risk factors and long-term outcomes require further study. We conducted a systematic, retrospective review of 1251 consecutive Australian children enrolled on BFM or COG-based protocols between 1998-2013. Clinical risk predictors for MTX neurotoxicity were analyzed using regression. A genome-wide association study (GWAS) was performed on 48 cases and 537 controls. The incidence of MTX neurotoxicity was 7.6% (n=95/1251), at a median of 4 months from ALL diagnosis and 8 days after intravenous or intrathecal MTX. Grade 3 elevation of serum aspartate aminotransferase (P=0.005, OR 2.31 (1.28-4.16)) in induction/consolidation was associated with MTX neurotoxicity, after accounting for the only established risk factor, age a10 years. Cumulative incidence of CNS relapse was increased in children where intrathecal MTX was omitted following symptomatic MTX neurotoxicity (n=48) compared to where intrathecal MTX was continued throughout therapy (n=1174) (P=0.047). Five-year CNS relapsefree survival was 89.2%±4.6% when intrathecal MTX was ceased compared to 95.4%±0.6% when intrathecal MTX was continued. Recurrence of MTX neurotoxicity was low (12.9%) for patients whose intrathecal MTX was continued after their first episode. The GWAS identified SNPs associated with MTX neurotoxicity near genes regulating neuronal growth, neuronal differentiation and cytoskeletal organization (P>1E-06). In conclusion, increased serum aspartate aminotransferase and age a10 years at diagnosis were independent risk factors for MTX neurotoxicity. Our data do not support cessation of intrathecal MTX after a first MTX neurotoxicity event.
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Affiliation(s)
- Marion K Mateos
- Kids Cancer Centre, Sydney Children's Hospital Randwick, Sydney, Australia; School of Women and Children's Health, University of New South Wales (UNSW), Sydney, Australia; Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Sydney, Australia; Northern Institute for Cancer Research, Wolfson Childhood Cancer Research Centre, Newcastle-Upon-Tyne
| | - Glenn M Marshall
- Kids Cancer Centre, Sydney Children's Hospital Randwick, Sydney, Australia; School of Women and Children's Health, University of New South Wales (UNSW), Sydney, Australia; Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Sydney
| | - Pasquale M Barbaro
- Children's Medical Research Institute, University of Sydney, Sydney, Australia; Department of Haematology, Queensland Children's Hospital, Brisbane
| | | | - Carly George
- Perth Children's Hospital, Perth, Australia; Division of Paediatrics, School of Medicine, University of Western Australia, Perth
| | - Chelsea Mayoh
- School of Women and Children's Health, University of New South Wales (UNSW), Sydney, Australia; Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Sydney
| | - Rosemary Sutton
- School of Women and Children's Health, University of New South Wales (UNSW), Sydney, Australia; Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Sydney
| | | | - Jodie E Giles
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Sydney
| | - Draga Barbaric
- Kids Cancer Centre, Sydney Children's Hospital Randwick, Sydney
| | - Frank Alvaro
- John Hunter Children's Hospital, Newcastle, Australia; University of Newcastle, Newcastle
| | - Françoise Mechinaud
- The Royal Children's Hospital, Melbourne, Australia; Service d'Immuno-hématologie pédiatrique Hôpital Robert-Debré, Paris
| | - Daniel Catchpoole
- The Tumour Bank, Children's Cancer Research Unit, The Children's Hospital at Westmead, Sydney
| | - John A Lawson
- School of Women and Children's Health, University of New South Wales (UNSW), Sydney, Australia; Department of Neurology, Sydney Children's Hospital Randwick, Sydney
| | | | | | - Rishi S Kotecha
- Perth Children's Hospital, Perth, Australia; Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, Australia; School of Pharmacy and Biomedical Sciences, Curtin University, Perth
| | - Luciano Dalla-Pozza
- Children's Medical Research Institute, University of Sydney, Sydney, Australia; Cancer Centre for Children, The Children's Hospital at Westmead, Sydney, Australia; Children's Cancer Research Unit, The Children's Hospital at Westmead, Sydney
| | - Toby N Trahair
- Kids Cancer Centre, Sydney Children's Hospital Randwick, Sydney, Australia; School of Women and Children's Health, University of New South Wales (UNSW), Sydney, Australia; Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Sydney.
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17
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Abstract
PURPOSE OF REVIEW Tremendous advances have been made in the treatment armamentarium for acute lymphoblastic leukemia in recent years, which have substantially improved outcomes for these patients. At the same time, unique toxicities have emerged, and without early intervention, are life-threatening. This article will review the novel therapies in acute leukemias and highlight the clinically relevant supportive care advances. RECENT FINDINGS The American Society for Transplantation and Cellular Therapy (ASTCT) has put forth the most recent recommendations in managing the cytokine release syndrome and neurotoxicity after chimeric antigen receptor T cells (CAR-T) and blinatumomab. The hepatic injury incurred by inotuzumab, and the vascular toxicity of tyrosine kinase inhibitors, other relatively novel agents, require subspecialist intervention and multidisciplinary care. Asparaginase, a long-established and key element of pediatric regimens, has made a comeback in the young adult leukemia population. Updated guidelines have been outlined for management of asparaginase thrombotic complications. Lastly, although there have been few changes in the applications of growth factor, antimicrobial prophylaxis, and management of neuropathy, these encompass exceedingly important aspects of care. While the rapidly changing treatment paradigms for acute lymphoblastic leukemia have transformed leukemia-specific outcomes, treatment emergent toxicities have forced much necessary attention to better definitions of these toxicities and on improving supportive care guidelines in acute lymphoblastic leukemia.
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18
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Rubinstein JD, Krupski C, Nelson AS, O'Brien MM, Davies SM, Phillips CL. Chimeric Antigen Receptor T Cell Therapy in Patients with Multiply Relapsed or Refractory Extramedullary Leukemia. Biol Blood Marrow Transplant 2020; 26:e280-e285. [PMID: 32755637 DOI: 10.1016/j.bbmt.2020.07.036] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/30/2020] [Accepted: 07/30/2020] [Indexed: 12/29/2022]
Abstract
Autologous CD19-directed chimeric antigen receptor T lymphocyte (CAR-T) therapy is an approved and effective treatment for the management of patients with refractory and multiply relapsed B cell precursor acute lymphoblastic leukemia (B-ALL). Experience using this therapy in pediatric patients with extramedullary (EM) disease is limited, in part because these patients have frequently been excluded from clinical trials owing to concerns for an increased risk of immune effector cell-associated neurotoxicity syndrome (ICANS). We infused 7 patients with refractory or multiply relapsed B-ALL who presented with isolated EM relapse with tisagenlecleucel. Six patients had isolated central nervous system (CNS) leukemia, and 1 patient had an isolated testicular relapse. An initial complete response was seen in all patients, with 5 patients remaining in CAR-T-induced remission at a median of 18 months from first infusion. Reversible ICANS was seen in 1 patient with CNS leukemia. Durable B cell aplasia occurred in 3 patients, with a median time to B cell recovery of 6.5 months in the other patients. These data suggest that CAR-T therapy has promising safety and efficacy in treating EM leukemia, although definitive conclusions are limited by the small size of the cohort and limited follow-up period.
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Affiliation(s)
- Jeremy D Rubinstein
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Oncology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| | - Christa Krupski
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Adam S Nelson
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Maureen M O'Brien
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Oncology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Stella M Davies
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Christine L Phillips
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Oncology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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19
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Salzer WL, Burke MJ, Devidas M, Dai Y, Hardy KK, Kairalla JA, Gore L, Hilden JM, Larsen E, Rabin KR, Zweidler-McKay PA, Borowitz MJ, Wood B, Heerema NA, Carroll AJ, Winick N, Carroll WL, Raetz EA, Loh ML, Hunger SP. Impact of Intrathecal Triple Therapy Versus Intrathecal Methotrexate on Disease-Free Survival for High-Risk B-Lymphoblastic Leukemia: Children's Oncology Group Study AALL1131. J Clin Oncol 2020; 38:2628-2638. [PMID: 32496902 DOI: 10.1200/jco.19.02892] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE The high-risk stratum of Children's Oncology Group Study AALL1131 was designed to test the hypothesis that postinduction CNS prophylaxis with intrathecal triple therapy (ITT) including methotrexate, hydrocortisone, and cytarabine would improve the postinduction 5-year disease-free survival (DFS) compared with intrathecal methotrexate (IT MTX), when given on a modified augmented Berlin-Frankfurt-Münster backbone. PATIENTS AND METHODS Children with newly diagnosed National Cancer Institute (NCI) high-risk B-cell acute lymphoblastic leukemia (HR B-ALL) or NCI standard-risk B-ALL with defined minimal residual disease thresholds during induction were randomly assigned to receive postinduction IT MTX or ITT. Patients with CNS3-status disease were not eligible. Postinduction IT therapy was given for a total of 21 to 26 doses. Neurocognitive assessments were performed during therapy and during 1 year off therapy. RESULTS Random assignment was closed to accrual in March 2018 after a futility boundary had been crossed, concluding that ITT could not be shown to be superior to IT MTX. The 5-year postinduction DFS and overall survival rates (± SE) of children randomly assigned to IT MTX versus ITT were 93.2% ± 2.1% v 90.6% ± 2.3% (P = .85), and 96.3% ± 1.5% v 96.7% ± 1.4% (P = .77), respectively. There were no differences in the cumulative incidence of isolated bone marrow relapse, isolated CNS relapse, or combined bone marrow and CNS relapse rates, or in toxicities observed for patients receiving IT MTX compared with ITT. There were no significant differences in neurocognitive outcomes for patients receiving IT MTX compared with ITT. CONCLUSION Postinduction CNS prophylaxis with ITT did not improve 5-year DFS for children with HR B-ALL. The standard of care for CNS prophylaxis for children with B-ALL and no overt CNS involvement remains IT MTX.
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Affiliation(s)
| | - Michael J Burke
- Department of Pediatrics, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Meenakshi Devidas
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Yunfeng Dai
- Department of Biostatistics, Colleges of Medicine and Public Health & Health Professions, University of Florida, Gainesville, FL
| | | | - John A Kairalla
- Department of Biostatistics, Colleges of Medicine and Public Health & Health Professions, University of Florida, Gainesville, FL
| | - Lia Gore
- Department of Pediatrics, Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, CO.,University of Colorado School of Medicine, Aurora, CO
| | - Joanne M Hilden
- Department of Pediatrics, Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, CO.,University of Colorado School of Medicine, Aurora, CO
| | - Eric Larsen
- Department of Pediatrics, Maine Children's Cancer Program, Scarborough, ME
| | - Karen R Rabin
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | | | - Michael J Borowitz
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Brent Wood
- Department of Laboratory Medicine, University of Washington, Seattle, WA
| | - Nyla A Heerema
- Department of Pathology, The Ohio State University School of Medicine, Columbus, OH
| | - Andrew J Carroll
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL
| | - Naomi Winick
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
| | - William L Carroll
- Department of Pediatrics, Perlmutter Cancer Center, New York University Langone Medical Center, New York, NY
| | - Elizabeth A Raetz
- Department of Pediatrics, Perlmutter Cancer Center, New York University Langone Medical Center, New York, NY
| | - Mignon L Loh
- Department of Pediatrics, Benioff Children's Hospital and the Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
| | - Stephen P Hunger
- Department of Pediatrics and the Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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20
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Capria S, Molica M, Mohamed S, Bianchi S, Moleti ML, Trisolini SM, Chiaretti S, Testi AM. A review of current induction strategies and emerging prognostic factors in the management of children and adolescents with acute lymphoblastic leukemia. Expert Rev Hematol 2020; 13:755-769. [PMID: 32419532 DOI: 10.1080/17474086.2020.1770591] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Acute lymphoblastic leukemia is the most frequent hematologic malignancy in children. Almost 95% of children potentially achieve a complete remission after the induction treatment, but over the last years, new insights in the genomic disease profile and in minimal residual disease detection techniques have led to an improvement in the prognostic stratification, identifying selected patients' subgroups with peculiar therapeutic needs. AREAS COVERED According to a comprehensive search of peer-review literature performed in Pubmed, in this review we summarize the recent evidences on the induction treatment strategies comprised in the children acute lymphoblastic leukemia scenario, focusing on the role of key drugs such as corticosteroids and asparaginase and discussing the crucial significance of the genomic characterization at baseline which may drive the proper induction treatment choice. EXPERT OPINION Current induction strategies already produce durable remissions in a significant proportion of standard-risk children with acute lymphoblastic leukemia. A broader knowledge of the biologic features related to acute lymphoblastic leukemia subtypes with worse prognosis, and an optimization of targeted drugs now available, might lead to the achievement of long-term molecular remissions in this setting.
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Affiliation(s)
- Saveria Capria
- Hematology, Department of Translational and Precision Medicine, 'Sapienza" University of Rome , Rome, Italy
| | - Matteo Molica
- Hematology, Department of Translational and Precision Medicine, 'Sapienza" University of Rome , Rome, Italy
| | - Sara Mohamed
- Hematology, Department of Translational and Precision Medicine, 'Sapienza" University of Rome , Rome, Italy
| | - Simona Bianchi
- Hematology, Department of Translational and Precision Medicine, 'Sapienza" University of Rome , Rome, Italy
| | - Maria Luisa Moleti
- Hematology, Department of Translational and Precision Medicine, 'Sapienza" University of Rome , Rome, Italy
| | - Silvia Maria Trisolini
- Hematology, Department of Translational and Precision Medicine, 'Sapienza" University of Rome , Rome, Italy
| | - Sabina Chiaretti
- Hematology, Department of Translational and Precision Medicine, 'Sapienza" University of Rome , Rome, Italy
| | - Anna Maria Testi
- Hematology, Department of Translational and Precision Medicine, 'Sapienza" University of Rome , Rome, Italy
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21
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He JB, Zhang X, Guo ZW, Liu MM, Xu N, Huang F, Fan ZP, Xuan L, Deng L, Lin SH, Xu J, Sun J, Liu QF. Ponatinib therapy in recurrent Philadelphia chromosome-positive central nervous system leukemia with T315I mutation after Allo-HSCT. Int J Cancer 2019; 147:1071-1077. [PMID: 31785158 DOI: 10.1002/ijc.32817] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 11/12/2019] [Accepted: 11/20/2019] [Indexed: 11/06/2022]
Abstract
Central nervous system leukemia (CNSL) relapse is relatively common among Philadelphia chromosome-positive (Ph+) leukemia patients who undergo allogeneic hematopoietic stem cell transplantation (allo-HSCT). The prognosis of patients is dismal for those with a BCR-ABL T315I mutation, which is resistant to TKIs including second-generation drugs. We assessed ponatinib for nine patients with recurrent Ph+ CNSL and a T315I mutation after allo-HSCT, including five patients with Ph+ acute lymphoblastic leukemia and four with chronic myelogenous leukemia. Five patients experienced isolated CNSL relapse, and four experienced CNSL with hematologic relapse. All patients received ponatinib combined with intrathecal chemotherapy, and four patients with hematologic relapse received systemic chemotherapy and/or donor lymphocyte infusion. All patients achieved a deep molecular response and central nervous system remission (CNSR) at a median time of 1.5 (range: 0.7-3) months after ponatinib treatment. Two patients experienced a second CNSL relapse due to ponatinib reduction, but they achieved CNSR again after an increase to the standard dosage. Six patients developed graft versus host disease. By April 1, 2019, eight patients were alive, and one died of pneumonia. The median time of survival after the first CNSL relapse posttransplantation was 18 (range: 11.2-48.5) months. Our data from a small number of samples suggests that ponatinib is effective for recurrent Ph+ CNSL patients with a BCR-ABL T315I mutation after allo-HSCT and warrants broader clinical evaluation.
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Affiliation(s)
- Jia-Bao He
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xin Zhang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zi-Wen Guo
- Department of Hematology, Zhongshan City People's Hospital, Zhongshan, China
| | - Miao-Miao Liu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Na Xu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Fen Huang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhi-Ping Fan
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Li Xuan
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Lan Deng
- Department of Hematology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Shu-Hua Lin
- Department of Hematology, Zhongshan City People's Hospital, Zhongshan, China
| | - Jun Xu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jing Sun
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qi-Fa Liu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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22
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Winick N, Martin PL, Devidas M, Shuster J, Borowitz MJ, Paul Bowman W, Larsen E, Pullen J, Carroll A, Willman C, Hunger SP, Carroll WL, Camitta BM. Randomized assessment of delayed intensification and two methods for parenteral methotrexate delivery in childhood B-ALL: Children's Oncology Group Studies P9904 and P9905. Leukemia 2019; 34:1006-1016. [PMID: 31728054 DOI: 10.1038/s41375-019-0642-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 10/11/2019] [Accepted: 11/03/2019] [Indexed: 11/12/2022]
Abstract
The delayed intensification (DI) enhanced outcome for patients with acute lymphoblastic leukemia (ALL) treated on BFM 76/79 and CCG 105 after a prednisone-based induction. Childrens Oncology Group protocols P9904/9905 evaluated DI via a post-induction randomization for eligible National Cancer Institute (NCI) standard (SR) and high-risk (HR) patients. A second randomization compared intravenous methotrexate (IV MTX) as a 24- (1 g/m2) vs. 4-h (2 g/m2) infusion. NCI SR patients received a dexamethasone-based three-drug and NCI HR/CNS 3 SR patients a prednisone-based four-drug induction. End induction MRD (minimal residual disease) was obtained but did not impact treatment. DI improved the 10-year continuous complete remission (CCR) rate; 75.5 ± 2.5% vs. 81.8 ± 2.2% p = 0.002, whereas MTX administration did not; 4-h 80.8 ± 1.9%; 24-h 81.4 ± 1.9% (p = 0.7780). Overall survival (OS) at 10 years did not differ with DI: 91.4 ± 1.6% vs. 90.9 ± 1.7% (p = 0.25) without but was higher with the 24-h MTX infusion; 4-h 91.1 ± 1.4%; 24-h 93.9 ± 1.2% (p = 0.0209). MRD predicted outcome; 10-year CCR 87.7 ± 2.2 and 82.1 ± 2.5% when MRD was <0.01% with/without DI (p = 0.007) and 54.3 ± 8% and 44 ± 8% for patients with MRD ≥ 0.01% with/without DI (p = 0.11). DI improved CCR for patients with B-ALL with and without end induction MRD.
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Affiliation(s)
- Naomi Winick
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Paul L Martin
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Meenakshi Devidas
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jonathan Shuster
- Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Michael J Borowitz
- Department of Pathology and Oncology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - W Paul Bowman
- Department of Pediatrics, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Eric Larsen
- Maine Children's Cancer Program, Scarborough, ME, USA
| | - Jeanette Pullen
- Department of Pediatrics, University of Mississippi, Jackson, MS, USA
| | - Andrew Carroll
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Cheryl Willman
- Cancer Center and Departments of Internal Medicine and Pathology, University of New Mexico, Albuquerque, NM, USA
| | - Stephen P Hunger
- Department of Pediatrics and the Center for Childhood Cancer Research, Children's Hospital of Philadelphia, and the Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA
| | - William L Carroll
- Department of Pediatrics and The Perlmutter Cancer Center, New York University Medical Center, New York, NY, USA
| | - Bruce M Camitta
- Department of Pediatrics, Midwest Center for Cancer and Blood Disorders, Medical College of Wisconsin, Milwaukee, WI, USA
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23
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Hofmans M, Suciu S, Ferster A, Van Vlierberghe P, Mazingue F, Sirvent N, Costa V, Yakouben K, Paillard C, Uyttebroeck A, Plantaz D, Plat G, Simon P, Millot F, Poirée M, van der Werff ten Bosch J, Piette C, Minckes O, Rohrlich P, Girard S, Cavé H, Bertrand Y, De Moerloose B. Results of successive EORTC‐CLG 58 881 and 58 951 trials in paediatric T‐cell acute lymphoblastic leukaemia (ALL). Br J Haematol 2019; 186:741-753. [DOI: 10.1111/bjh.15983] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 04/05/2019] [Indexed: 12/30/2022]
Affiliation(s)
- Mattias Hofmans
- Paediatric Haematology‐Oncology and Stem Cell Transplantation Ghent University Hospital GhentBelgium
- Department of Diagnostic Sciences Ghent University GhentBelgium
| | | | - Alina Ferster
- Department of Paediatric Haematology‐Oncology Children's University Hospital Queen FabiolaUniversité Libre de Bruxelles BrusselsBelgium
| | - Pieter Van Vlierberghe
- Cancer Research Institute Ghent GhentBelgium
- Center for Medical Genetics Ghent University Hospital Ghent Belgium
| | - Françoise Mazingue
- Department of Paediatric Haematology‐Oncology Centre Hospitalo‐Universitaire de Lille LilleFrance
| | - Nicolas Sirvent
- Department of Paediatric Haematology‐Oncology Centre Hospitalo‐Universitaire de Montpellier MontpellierFrance
- University Montpellier Montpellier France
| | - Vitor Costa
- Paediatric Department Instituto Português de Oncologia Porto Portugal
| | - Karima Yakouben
- Department of Paediatric Haematology Hôpital Robert DebréAP‐HP ParisFrance
| | - Catherine Paillard
- Department of Paediatric Haematology and Oncology Centre Hospitalo‐Universitaire de Strasbourg Strasbourg France
| | - Anne Uyttebroeck
- Department of Paediatric Haematology‐Oncology University Hospital Gasthuisberg Leuven Belgium
| | - Dominique Plantaz
- Department of Paediatric Oncology University Hospital GrenobleFrance
| | - Geneviève Plat
- Department of Paediatric Haematology‐Oncology Centre Hospitalo‐Universitaire, Hopital Purpan ToulouseFrance
| | - Pauline Simon
- Service Hématologie Oncologie Pédiatrique Centre Hospitalier Régional Universitaire de Besançon BesançonFrance
| | | | - Marilyne Poirée
- Department of Paediatric Haematology‐Oncology Centre Hospitalo‐Universitaire de Nice Nice France
| | | | - Caroline Piette
- Service Universitaire d'Hémato‐Oncologie Pédiatrique Liégeois (SUHOPL)CHR Citadelle Liège Belgium
| | - Odile Minckes
- Department of Paediatric Haematology‐Oncology Centre Hospitalo‐Universitaire de Caen CaenFrance
| | - Pierre Rohrlich
- Department of Paediatric Haematology‐Oncology Centre Hospitalo‐Universitaire de Nice Nice France
| | - Sandrine Girard
- Laboratory of Haematology Institute of Paediatric Haematology and Oncology (IHOP)Hospices Civils de Lyon LyonFrance
| | - Hélène Cavé
- Département de Génétique Assistance Publique des Hôpitaux de Paris (AP‐HP)Hôpital Robert Debré ParisFrance
- INSERM UMR_S1131 Institut de Recherche Saint‐LouisUniversité Paris Diderot ParisFrance
| | - Yves Bertrand
- Institute of Paediatric Haematology and Oncology (IHOP) Haematology UnitHospices Civils de Lyon and Claude Bernard University Lyon France
| | - Barbara De Moerloose
- Paediatric Haematology‐Oncology and Stem Cell Transplantation Ghent University Hospital GhentBelgium
- Cancer Research Institute Ghent GhentBelgium
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24
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Jin MY, Han Y, Liu YJ, Gu B, Chen J, Shi SS, Xu MZ, Cai CS, Tang YQ, Wu DP. [Treatment of central nervous system leukemia with CD19-chimeric antigen receptor T-cell immunotherapy: two cases report and literature review]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 39:650-653. [PMID: 30180466 PMCID: PMC7342845 DOI: 10.3760/cma.j.issn.0253-2727.2018.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
目的 探讨CAR-T细胞治疗中枢神经系统白血病(CNSL)的有效性和安全性。 方法 报道两例合并CNSL白血病患者抗CD19 CAR-T细胞治疗的过程及结果,并对相关文献进行复习。 结果 两例患者骨髓细胞形态学特征分别为伴B淋系表达的急性髓系白血病(AML)-M2和急性B淋巴细胞白血病(B-ALL),免疫分型符合AML-M2和B-ALL的异常表现,临床和实验室检查符合CNSL诊断标准,诊断明确后予以抗CD19 CAR-T细胞治疗,输注总量均为5.0×106/kg。回输后两例患者中枢神经系统症状缓解。例1影像学异常消失,治疗过程中出现细胞因子释放综合征(CRS),药物干预后好转;例2脑脊液微小残留病转阴,未出现明显CRS反应。 结论 CAR-T细胞治疗有望缓解CNSL,改善患者预后。
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Affiliation(s)
- M Y Jin
- The First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, Collaborative Innovation Centre of Hematology, Institute of Hematopoietic Stem Cell Transplantation, Key Laboratory of Thrombosis and Haemostasis of Ministry of Health, Suzhou 215006, China
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25
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Kinjyo I, Bragin D, Grattan R, Winter SS, Wilson BS. Leukemia-derived exosomes and cytokines pave the way for entry into the brain. J Leukoc Biol 2019; 105:741-753. [PMID: 30702754 DOI: 10.1002/jlb.3a0218-054r] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 12/07/2018] [Accepted: 01/02/2019] [Indexed: 12/25/2022] Open
Abstract
Infiltration of acute lymphoblastic leukemia (ALL) blasts into the CNS remains as a major clinical problem, with high risk for chemotherapy-resistant relapse and treatment-related morbidity. Despite the common inclusion of CNS prophylaxis treatments in therapy regimens, there are significant gaps in understanding the mechanisms that mediate leukemia cell entry into the CNS as well as roles for resident cells in the brain. In this study, we employ a xenograft model of human B cell precursor (BCP)-ALL in immunocompromised mice. This model system recapitulates key pathological characteristics of leptomeningeal involvement seen in patients and provides insights into rare cases that involve parenchymal invasion. We examine the infiltration of engrafted leukemia blasts into brains of recipient mice and provide evidence that the interaction between blasts and brain resident cells causes aberrant activation of host cells in the brain microenvironment. BCP-ALL blasts also release multiple cytokines and exosomes containing IL-15 that bind and are internalized by astrocytes and brain vessel endothelial cells. Leukemic invasion is linked to production of VEGF-AA by astrocytes and disruption of the blood-brain-barrier (BBB) integrity. Knockdown of either IL-15 or IL-15Rα in the NALM6 cell line decreases CNS infiltration in engrafted mice. These results provide important insights into the multiple mechanisms by which lymphoblasts modulate the brain microenvironment to breach the BBB for metastatic invasion.
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Affiliation(s)
- Ichiko Kinjyo
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Denis Bragin
- Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico, USA
| | - Rachel Grattan
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Stuart S Winter
- Blood Diseases and Cancer Program, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, USA
| | - Bridget S Wilson
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA.,Comprehensive Cancer Center, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
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26
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Kim HA, Jang H, Kim YK, Kim D, Kim JY. Characteristic Features of Pneumocystis Pneumonia in Pediatric Acute Lymphoblastic Leukemia. CLINICAL PEDIATRIC HEMATOLOGY-ONCOLOGY 2018. [DOI: 10.15264/cpho.2018.25.2.154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Hyeon A Kim
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Haemin Jang
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Yu Kyung Kim
- Department of Clinical Pathology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Dongsub Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Yoon Kim
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
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27
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Li J, Li X, Tong X, Liu J, Huang B, Chen M, Kuang L, Zhou Z, Xu D. Investigation of the optimal duration of bed rest in the supine position to reduce complications after lumbar puncture combined with intrathecal chemotherapy: a multicenter prospective randomized controlled trial. Support Care Cancer 2018; 26:2995-3002. [PMID: 29546527 PMCID: PMC6096529 DOI: 10.1007/s00520-018-4142-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 03/02/2018] [Indexed: 11/28/2022]
Abstract
Purpose This randomized, open-label trial was conducted to investigate the optimal duration of bed rest after intrathecal chemotherapy to reduce the incidence of complications without increasing patients’ tolerance to long-term bed rest. Methods A total of 390 patients receiving intrathecal chemotherapy were randomly assigned 1:1:1 to undergo bed rest for 6, 8, or 10 h after intrathecal chemotherapy. The primary outcome was the rate of complications after intrathecal chemotherapy. The analysis was per protocol. Results A total of 359 patients among the 390 patients in our study completed follow-up with 120 patients in the 6-h group, 120 in the 8-h group, and 119 in the 10-h group. The complications among the three groups differed significantly (P = 0.005). The 6-h group had significantly more complications than the 8- (50, 41.7% vs 29, 24.2%, P = 0.004) and 10-h groups (50, 41.7% vs 31, 26.1%, P = 0.011), whereas the difference between the 8- and 10-h groups was not significant (29, 24.2% vs 31, 26.1%, P = 0.737). Conclusions The overall results support that the optimal time interval for bed rest in the supine position after intrathecal chemotherapy is 8 h. This trial is registered with the Chinese Clinical Trial Registry (number ChiCTR-IOR-17011671).
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Affiliation(s)
- Juan Li
- Department of Hematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, 510000, China.
| | - Xiaozhe Li
- Department of Hematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, 510000, China
| | - Xiuzhen Tong
- Department of Hematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, 510000, China
| | - Junru Liu
- Department of Hematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, 510000, China
| | - Beihui Huang
- Department of Hematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, 510000, China
| | - Meilan Chen
- Department of Hematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, 510000, China
| | - Lifen Kuang
- Department of Hematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, 510000, China
| | - Zhenhai Zhou
- Department of Hematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, 510000, China
| | - Duorong Xu
- Department of Hematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, 510000, China
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28
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Kim SY, Park JH, Yoon SY, Cho YH, Lee MH. A pilot study of daunorubicin-augmented hyper-CVAD induction chemotherapy for adults with acute lymphoblastic leukemia. Cancer Chemother Pharmacol 2018; 81:393-398. [PMID: 29294168 DOI: 10.1007/s00280-017-3514-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 12/28/2017] [Indexed: 11/29/2022]
Abstract
Induction of complete remission (CR) is imperative for long-term survival in adult acute lymphoblastic leukemia (ALL) patients regardless of transplantation eligibility. Hyper-CVAD chemotherapy is a widely-used frontline remission induction regimen for these patients. We conducted a pilot trial of frontline remission induction using daunorubicin-augmented hyper-CVAD regimen (hyper-CVDD) in adult ALL patients (n = 15). The CR rate after this modified regimen was 100% (n = 15). Twelve patients were able to proceed to allogeneic hematopoietic cell transplantation, two patients died before transplantation due to infection, and the remaining one who was ineligible for transplant due to her age received an additional five courses of consolidation chemotherapy. Overall survival (OS) and event-free survival (EFS) of the study patients was 61.0 and 47.5% at 3 years. OS and relapse-free survival of transplanted patients was 66.8 and 55.0% at 3 years. This pilot trial demonstrates the favorable efficacy of the hyper-CVDD chemotherapy as a frontline remission induction regimen. Further clinical trials using this regimen are warranted.
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Affiliation(s)
- Sung-Yong Kim
- Department of Hematology/Oncology, Konkuk University School of Medicine, Konkuk University, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, 143-729, Republic of Korea.
| | - Ji Hyun Park
- Department of Hematology/Oncology, Konkuk University School of Medicine, Konkuk University, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, 143-729, Republic of Korea
| | - So Young Yoon
- Department of Hematology/Oncology, Konkuk University School of Medicine, Konkuk University, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, 143-729, Republic of Korea
| | - Yo-Han Cho
- Department of Hematology/Oncology, Konkuk University School of Medicine, Konkuk University, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, 143-729, Republic of Korea
| | - Mark Hong Lee
- Department of Hematology/Oncology, Konkuk University School of Medicine, Konkuk University, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, 143-729, Republic of Korea
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29
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Schlatter J, Nguyen D, Zamy M, Kabiche S, Fontan JE, Cisternino S. Safety of intrathecal route: focus to methylprednisolone acetate (Depo-Medrol) use. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 28:21-30. [DOI: 10.1007/s00586-017-5387-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 07/24/2017] [Accepted: 11/05/2017] [Indexed: 11/24/2022]
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30
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Jaime-Pérez JC, Pinzón-Uresti MA, Jiménez-Castillo RA, Colunga-Pedraza JE, González-Llano Ó, Gómez-Almaguer D. Relapse of childhood acute lymphoblastic leukemia and outcomes at a reference center in Latin America: organomegaly at diagnosis is a significant clinical predictor. ACTA ACUST UNITED AC 2017; 23:1-9. [PMID: 28580844 DOI: 10.1080/10245332.2017.1333294] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Relapse is the major cause of treatment failure in acute lymphoblastic leukemia (ALL) of childhood; it is more frequent among high-risk patients from low-middle income than from high-income countries. The frequency, sites and outcome of relapsed ALL in children of northeast Mexico over a decade was documented. METHODS A retrospective analysis of 246 children belonging to a low-income group <16 years with de novo ALL during 2004-2015 was performed. Five-year overall survival (OS) and event-free survival was estimated by Kaplan-Meier analysis. Data on time, site, response to therapy and final outcome of relapse were analyzed. Hazard ratios (HRs) of relapse and death were estimated by the Cox regression model. Very early relapse was defined as that occurring in <18 months, early relapse between 18 and 36 months, and late relapse >36 months from diagnosis, respectively. RESULTS Eighty-seven (35.4%) children relapsed. Five-year OS was 82.6% in children without relapse vs. 42% for relapsed patients. Bone marrow (BM) was the most frequent site of relapse (51.72%). Isolated central nervous system (CNS) relapses occurred in 29.9%. Five-year OS was 11.2% for BM and 15.5% for early relapse. HR of relapse for organomegaly was 3.683, 2.247 for an initial white blood cell count >50 000 × 109/l and 1.169 for positive minimal residual disease status. CONCLUSION A high rate of very early, CNS, and BM relapse with a considerably low 5-year OS requiring reassessment of therapy was documented. Organomegaly at diagnosis was a highly significant clinical predictor for relapse.
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Affiliation(s)
- José Carlos Jaime-Pérez
- a Department of Hematology , Dr. José Eleuterio González University Hospital of the School of Medicine, Universidad Autónoma de Nuevo León , Monterrey , Mexico
| | - Mónica Andrea Pinzón-Uresti
- a Department of Hematology , Dr. José Eleuterio González University Hospital of the School of Medicine, Universidad Autónoma de Nuevo León , Monterrey , Mexico
| | - Raúl Alberto Jiménez-Castillo
- a Department of Hematology , Dr. José Eleuterio González University Hospital of the School of Medicine, Universidad Autónoma de Nuevo León , Monterrey , Mexico
| | - Julia Esther Colunga-Pedraza
- a Department of Hematology , Dr. José Eleuterio González University Hospital of the School of Medicine, Universidad Autónoma de Nuevo León , Monterrey , Mexico
| | - Óscar González-Llano
- a Department of Hematology , Dr. José Eleuterio González University Hospital of the School of Medicine, Universidad Autónoma de Nuevo León , Monterrey , Mexico
| | - David Gómez-Almaguer
- a Department of Hematology , Dr. José Eleuterio González University Hospital of the School of Medicine, Universidad Autónoma de Nuevo León , Monterrey , Mexico
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31
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Abstract
The central nervous system (CNS) is an important site of involvement by acute lymphoblastic leukemia (ALL) in adults. The prevalence is sufficiently high that prophylactic treatment is routinely given to this sanctuary site in order to eradicate occult disease that might otherwise lead to a relapse. A lumbar puncture should be routinely performed in all newly diagnosed patients with ALL. The risks of CNS leukemia vary by phenotype and genotype. Preventive treatment of the CNS during post-remission therapy has become an integral part of all current ALL treatment protocols. Most treatment regimens combine multiple doses of intrathecal chemotherapy with high-dose systemic methotrexate and/or cytarabine. Cranial irradiation is less commonly used for prophylaxis but is still the most effective treatment for overt CNS leukemia. Recurrences within the CNS usually coincide with or predict soon afterwards for systemic relapse in the marrow and blood.
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Affiliation(s)
- Richard A Larson
- a Department of Medicine, Section of Hematology/Oncology, and Comprehensive Cancer Center , The University of Chicago , Chicago , IL , USA
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Jaime-Pérez JC, Gamboa-Alonso CM, Jiménez-Castillo RA, López-Silva LJ, Pinzón-Uresti MA, Gómez-De León A, Gómez-Almaguer D. TNF-α increases in the CSF of children with acute lymphoblastic leukemia before CNS relapse. Blood Cells Mol Dis 2016; 63:27-31. [PMID: 28061377 DOI: 10.1016/j.bcmd.2016.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 12/21/2016] [Indexed: 12/21/2022]
Abstract
There is scarce information regarding the concentration of cytokines in cerebrospinal fluid (CSF) of children with acute lymphoblastic leukemia (ALL) and their clinical association with CNS status. A prospective analysis of 40 patients <18years with newly diagnosed ALL was performed. Human cytokine magnetic bead panel assay values of IL-2, IL-4, IL-6, IL-8, IL-10, MCP-1, TNF-α in CSF at diagnosis, end of induction to remission, and 6months after diagnosis were determined. IL-6 and MCP-1 values showed a significant increment at the end of induction. From the whole group 4 (10.0%), patients relapsed to the CNS at a median of 11.48months. A significantly higher value of TNF-α at third determination in these CNS-relapsed patients was documented, 7.48 vs. 2.86pg/mL in 36 children without relapse (p=0.024). TNF-α concentration increased at a median 5.48months before CNS relapse. By receiver-operating characteristic curve (ROC) analysis, the best cut-off point of TNF-α concentration that better predicted CNS relapse was ≥1.79pg/mL. In conclusion an increase in TNF-α concentration on CSF preceded CNS relapse in children with ALL. An increase in MCP-1 and IL-6 was not associated to CNS relapse and appears to result from an inflammatory response after IT injection of chemotherapy.
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Affiliation(s)
- José Carlos Jaime-Pérez
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico.
| | - Carmen Magdalena Gamboa-Alonso
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Raúl Alberto Jiménez-Castillo
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Leslie Jazmín López-Silva
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Mónica Andrea Pinzón-Uresti
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Andrés Gómez-De León
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - David Gómez-Almaguer
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
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Olmos-Jiménez R, Díaz-Carrasco MS, Galera-Miñarro A, Pascual-Gazquez JF, Espuny-Miró A. Evaluation of standardized triple intrathecal therapy toxicity in oncohematological pediatric patients. Int J Clin Pharm 2016; 39:126-132. [PMID: 27933487 DOI: 10.1007/s11096-016-0408-0] [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] [Received: 07/12/2016] [Accepted: 12/01/2016] [Indexed: 10/20/2022]
Abstract
Background The administration of triple intrathecal therapy with methotrexate, cytarabine and a corticosteroid for the prophylaxis and treatment of neoplastic cell infiltration in the central nervous system in hematological malignancies is a widespread practice. There is limited information available about its toxicity profile. Several factors related to intrathecal preparation can affect toxicity. Thus, it was decided to standardize intrathecal chemotherapy, trying to obtain the best toxicity profile. Objective To assess the toxicity of a standardized triple intrathecal chemotherapy in oncohematological pediatric patients and to establish risk factors of toxicity. Setting Oncohematological pediatric unit from a tertiary hospital in Spain. Methods Prospective, descriptive and observational study in which all the administrations of standardized triple intrathecal chemotherapy in pediatric patients were registered. Main outcome measure Toxicity of the intrathecal therapy was recorded and possible risk factors were assessed. Results A total of 269 administrations of triple intrathecal chemotherapy were registered in 41 patients (mean age = 6.6 ± 3.9 years). In 16.7% of the procedures, an adverse event was reported (total number of adverse events = 61). 47.5% were grade 1, 47.5% grade 2 and 4.9% grade 3. The administration of intrathecal chemotherapy inpatient and patient age ≥3 years were risk factors of toxicity in the multivariate analysis. Conclusions The administration of standardized triple intrathecal chemotherapy is related to a low frequency of toxicity and most of the adverse events registered were mild/moderate. The detection of adverse effects was significantly greater in children with age greater than or equal to three years and in hospitalized patients.
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Affiliation(s)
- Raquel Olmos-Jiménez
- Pharmacology Department, Faculty of Medicine, University of Murcia, Campus de Espinardo, 30.071, Murcia, Spain.
| | - María Sacramento Díaz-Carrasco
- Pharmacy Service, Virgen de la Arrixaca Clinical University Hospital, Madrid-Cartagena Road, El Palmar, 30.120, Murcia, Spain
| | - Ana Galera-Miñarro
- Pediatric Oncohematology Department, Pediatric Service, Virgen de la Arrixaca Clinical University Hospital, Madrid-Cartagena Road, El Palmar, 30.120, Murcia, Spain
| | - Juan Francisco Pascual-Gazquez
- Pediatric Oncohematology Department, Pediatric Service, Virgen de la Arrixaca Clinical University Hospital, Madrid-Cartagena Road, El Palmar, 30.120, Murcia, Spain
| | - Alberto Espuny-Miró
- Pharmacology Department, Faculty of Medicine, University of Murcia, Campus de Espinardo, 30.071, Murcia, Spain
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Ivanov DP, Al-Rubai AJ, Grabowska AM, Pratten MK. Separating chemotherapy-related developmental neurotoxicity from cytotoxicity in monolayer and neurosphere cultures of human fetal brain cells. Toxicol In Vitro 2016; 37:88-96. [PMID: 27622579 DOI: 10.1016/j.tiv.2016.09.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 08/01/2016] [Accepted: 09/09/2016] [Indexed: 12/22/2022]
Abstract
Chemotherapy-induced neurotoxicity can reduce the quality of life of patients by affecting their intelligence, senses and mobility. Ten percent of safety-related late-stage clinical failures are due to neurological side effects. Animal models are poor in predicting human neurotoxicity due to interspecies differences and most in vitro assays cannot distinguish neurotoxicity from general cytotoxicity for chemotherapeutics. We developed in vitro assays capable of quantifying the paediatric neurotoxic potential for cytotoxic drugs. Mixed cultures of human fetal brain cells were differentiated in monolayers and as 3D-neurospheres in the presence of non-neurotoxic chemotherapeutics (etoposide, teniposide) or neurotoxicants (methylmercury). The cytotoxic potency towards dividing progenitors versus differentiated neurons and astrocytes was compared using: (1) immunohistochemistry staining and cell counts in monolayers; (2) through quantitative Western blots in neurospheres; and (3) neurosphere migration assays. Etoposide and teniposide, were 5-10 times less toxic to differentiated neurons compared to the mix of all cells in monolayer cultures. In contrast, the neurotoxicant methylmercury did not exhibit selectivity and killed all cells with the same potency. In 3D neurospheres, etoposide and teniposide were 24 to 10 times less active against neurons compared to all cells. These assays can be used prioritise drugs for local drug delivery to brain tumours.
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Affiliation(s)
- Delyan P Ivanov
- Cancer Biology, Division of Cancer and Stem Cells, School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK.
| | - Abdal-Jabbar Al-Rubai
- School of Life Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, UK.
| | - Anna M Grabowska
- Cancer Biology, Division of Cancer and Stem Cells, School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK.
| | - Margaret K Pratten
- School of Life Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, UK.
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35
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Sitthi-Amorn J, Collier AB. Off-therapy procedures are not beneficial in pediatric B-cell acute lymphoblastic leukemia. Pediatr Hematol Oncol 2016; 33:151-6. [PMID: 27110933 DOI: 10.3109/08880018.2016.1156204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Acute lymphoblastic leukemia (ALL) is the most common childhood cancer. Although curable, approximately 20% of patients relapse. In an effort to detect relapse earlier, our institution performed surveillance bone marrow (BM) and cerebrospinal fluid (CSF) evaluations every 3 months from the end of therapy to 1 year off. This study retrospectively reviewed all patients with B-cell ALL (B-ALL) from September 2005 to September 2010 to determine the benefit and cost of these procedures. Forty-one patients completed therapy and had 190 BMs and 190 lumbar punctures (LPs) performed. Four of 41 patients (9.8%) experienced a relapse. Relapse was detected in only 1 patient by routine BM evaluation (0.5%). Zero LPs were positive. The professional fees for the procedures were $8,738/patient. Therefore, off-therapy BM and CSF evaluations are not effective at detecting relapse and are expensive. Our institution has abandoned off-therapy surveillance for ALL.
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Affiliation(s)
- Jitsuda Sitthi-Amorn
- a Staff Physician, Hospitalist Medicine , St. Jude Children's Research Hospital , Memphis , Tennessee , USA
| | - Anderson B Collier
- b Department of Pediatric Hematology-Oncology , University of Mississippi Medical Center , Jackson , Mississippi , USA
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Matloub Y, Stork L, Asselin B, Hunger SP, Borowitz M, Jones T, Bostrom B, Gastier-Foster JM, Heerema NA, Carroll A, Winick N, Carroll WL, Camitta B, Devidas M, Gaynon PS. Outcome of Children with Standard-Risk T-Lineage Acute Lymphoblastic Leukemia--Comparison among Different Treatment Strategies. Pediatr Blood Cancer 2016; 63:255-61. [PMID: 26485054 PMCID: PMC4715507 DOI: 10.1002/pbc.25793] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 08/26/2015] [Accepted: 09/11/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND Children with T-lineage acute lymphoblastic leukemia ALL (T-ALL) historically have had inferior outcomes compared with the children with precursor-B ALL (B-ALL). After 1995, the Children's Cancer Group (CCG) treated patients with B- and T-ALL according to the National Cancer Institute (NCI) risk criteria, basing risk stratification on age and white blood cell (WBC) count regardless of immunophenotype. The Pediatric Oncology Group (POG) treated all the patients with T-ALL on separate, generally more intensive protocols than those used to treat the patients with B-ALL. PROCEDURE We compared the outcomes of children with T-ALL and NCI standard-risk (SR) criteria treated on CCG and POG trials between 1996 and 2005. CCG SR-ALL 1952 and 1991 enrolled 80 and 86 patients with T-ALL, respectively, utilizing a reduced intensity Berlin-Frankfurt-Münster backbone. Treatment was intensified for slow early responders and only patients with overt central nervous system leukemia received cranial irradiation. Eighty-four patients with T-ALL and SR features were enrolled on POG 9404 comprising more intensive therapy with all patients receiving cranial irradiation. RESULTS The 7-year event-free survival (EFS) for patients with SR T-ALL on CCG 1952, CCG 1991, and POG 9404 were 74.1 ± 5.8%, 81.8 ± 5.3%, and 84.2 ± 4.3%, respectively (P = 0.18). Overall 7-year survivals were 86.1 ± 4.6%, 88.3 ± 4.4%, 89.1 ± 3.6%, respectively (P = 0.84). CONCLUSIONS Comparable high rates of EFS and long-term survival were achieved with all three regimens, with the CCG regimens utilizing a less intensive chemotherapy backbone without prophylactic cranial irradiation for patients with SR T-ALL.
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Affiliation(s)
- Yousif Matloub
- Rainbow Babies & Children’s Hospital, Division of Hematology-Oncology, Case Western Reserve University, Cleveland, Ohio
| | - Linda Stork
- Doernbecher Children’s Hospital, Division of Hematology-Oncology, Oregon Health & Science University, Portland, Oregon
| | - Barbara Asselin
- Golisano Children’s Hospital, Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
| | | | - Michael Borowitz
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Tamekia Jones
- Children’s Foundation Research Institute, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Bruce Bostrom
- Children’s Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
| | - Julie M. Gastier-Foster
- Department of Pathology and Laboratory Medicine, Nationwide Children’s Hospital, Columbus, Ohio
- Department of Pathology, The Ohio State University College of Medicine, Columbus, Ohio
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Nyla A. Heerema
- Department of Pathology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Andrew Carroll
- Department of Genetics, University of Alabama at Birmingham, Alabama
| | - Naomi Winick
- Division of Hematology-Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Bruce Camitta
- Midwest Center for Cancer and Blood Disorders, Pediatric Hematology-Oncology, Milwaukee, Wisconsin
| | - Meenakshi Devidas
- Department of Biostatistics, Colleges of Medicine, Public Health & Health Professions, Children’s University of Florida, Gainsville, Florida
| | - Paul S. Gaynon
- Division of Hematology-Oncology, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, California
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Vora A, Andreano A, Pui CH, Hunger SP, Schrappe M, Moericke A, Biondi A, Escherich G, Silverman LB, Goulden N, Taskinen M, Pieters R, Horibe K, Devidas M, Locatelli F, Valsecchi MG. Influence of Cranial Radiotherapy on Outcome in Children With Acute Lymphoblastic Leukemia Treated With Contemporary Therapy. J Clin Oncol 2016; 34:919-26. [PMID: 26755523 DOI: 10.1200/jco.2015.64.2850] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE We sought to determine whether cranial radiotherapy (CRT) is necessary to prevent relapse in any subgroup of children with acute lymphoblastic leukemia (ALL). PATIENTS AND METHODS We obtained aggregate data on relapse and survival outcomes for 16,623 patients age 1 to 18 years old with newly diagnosed ALL treated between 1996 and 2007 by 10 cooperative study groups from around the world. The proportion of patients eligible for prophylactic CRT varied from 0% to 33% by trial and was not related to the proportion eligible for allogeneic stem-cell transplantation in first complete remission. Using a random effects model, with CRT as a dichotomous covariate, we performed a single-arm meta-analysis to compare event-free survival and cumulative incidence of isolated or any CNS relapse and isolated bone marrow relapse in high-risk subgroups of patients who either did or did not receive CRT. RESULTS Although there was significant heterogeneity in all outcome end points according to trial, CRT was associated with a reduced risk of relapse only in the small subgroup of patients with overt CNS disease at diagnosis, who had a significantly lower risk of isolated CNS relapse (4% with CRT v 17% without CRT; P = .02) and a trend toward lower risk of any CNS relapse (7% with CRT v 17% without CRT; P = .09). However, this group had a relatively high rate of events regardless of whether or not they received CRT (32% [95% CI, 26% to 39%] v 34% [95% CI, 19% to 54%]; P = .8). CONCLUSION CRT does not have an impact on the risk of relapse in children with ALL treated on contemporary protocols.
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Affiliation(s)
- Ajay Vora
- Ajay Vora, Sheffield Children's Hospital and University of Sheffield, Sheffield; Nicholas Goulden, Great Ormond Street Hospital, London, United Kingdom; Anita Andreano and Maria Grazia Valsecchi, School of Medicine and Surgery, University of Milano-Bicocca, Milan; Andrea Biondi, University of Milano-Bicocca, Monza; Franco Locatelli, Bambino Gesù Children's Hospital, Rome, and University of Pavia, Pavia, Italy; Ching-Hon Pui, St Jude Children's Research Hospital and University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Lewis B. Silverman, Dana-Faber Cancer Institute and Boston Children's Hospital, Boston, MA; Meenakshi Devidas, Children's Oncology Group Statistics and Data Center and University of Florida, Gainesville, FL; Martin Schrappe and Anja Moericke, University Medical Centre and Christian-Albrechts-University, Kiel; Gabriele Escherich, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Mervi Taskinen, Helsinki University Hospital, Helsinki, Finland; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, and Dutch Childhood Oncology Group, the Hague, the Netherlands; and Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan.
| | - Anita Andreano
- Ajay Vora, Sheffield Children's Hospital and University of Sheffield, Sheffield; Nicholas Goulden, Great Ormond Street Hospital, London, United Kingdom; Anita Andreano and Maria Grazia Valsecchi, School of Medicine and Surgery, University of Milano-Bicocca, Milan; Andrea Biondi, University of Milano-Bicocca, Monza; Franco Locatelli, Bambino Gesù Children's Hospital, Rome, and University of Pavia, Pavia, Italy; Ching-Hon Pui, St Jude Children's Research Hospital and University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Lewis B. Silverman, Dana-Faber Cancer Institute and Boston Children's Hospital, Boston, MA; Meenakshi Devidas, Children's Oncology Group Statistics and Data Center and University of Florida, Gainesville, FL; Martin Schrappe and Anja Moericke, University Medical Centre and Christian-Albrechts-University, Kiel; Gabriele Escherich, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Mervi Taskinen, Helsinki University Hospital, Helsinki, Finland; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, and Dutch Childhood Oncology Group, the Hague, the Netherlands; and Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Ching-Hon Pui
- Ajay Vora, Sheffield Children's Hospital and University of Sheffield, Sheffield; Nicholas Goulden, Great Ormond Street Hospital, London, United Kingdom; Anita Andreano and Maria Grazia Valsecchi, School of Medicine and Surgery, University of Milano-Bicocca, Milan; Andrea Biondi, University of Milano-Bicocca, Monza; Franco Locatelli, Bambino Gesù Children's Hospital, Rome, and University of Pavia, Pavia, Italy; Ching-Hon Pui, St Jude Children's Research Hospital and University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Lewis B. Silverman, Dana-Faber Cancer Institute and Boston Children's Hospital, Boston, MA; Meenakshi Devidas, Children's Oncology Group Statistics and Data Center and University of Florida, Gainesville, FL; Martin Schrappe and Anja Moericke, University Medical Centre and Christian-Albrechts-University, Kiel; Gabriele Escherich, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Mervi Taskinen, Helsinki University Hospital, Helsinki, Finland; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, and Dutch Childhood Oncology Group, the Hague, the Netherlands; and Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Stephen P Hunger
- Ajay Vora, Sheffield Children's Hospital and University of Sheffield, Sheffield; Nicholas Goulden, Great Ormond Street Hospital, London, United Kingdom; Anita Andreano and Maria Grazia Valsecchi, School of Medicine and Surgery, University of Milano-Bicocca, Milan; Andrea Biondi, University of Milano-Bicocca, Monza; Franco Locatelli, Bambino Gesù Children's Hospital, Rome, and University of Pavia, Pavia, Italy; Ching-Hon Pui, St Jude Children's Research Hospital and University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Lewis B. Silverman, Dana-Faber Cancer Institute and Boston Children's Hospital, Boston, MA; Meenakshi Devidas, Children's Oncology Group Statistics and Data Center and University of Florida, Gainesville, FL; Martin Schrappe and Anja Moericke, University Medical Centre and Christian-Albrechts-University, Kiel; Gabriele Escherich, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Mervi Taskinen, Helsinki University Hospital, Helsinki, Finland; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, and Dutch Childhood Oncology Group, the Hague, the Netherlands; and Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Martin Schrappe
- Ajay Vora, Sheffield Children's Hospital and University of Sheffield, Sheffield; Nicholas Goulden, Great Ormond Street Hospital, London, United Kingdom; Anita Andreano and Maria Grazia Valsecchi, School of Medicine and Surgery, University of Milano-Bicocca, Milan; Andrea Biondi, University of Milano-Bicocca, Monza; Franco Locatelli, Bambino Gesù Children's Hospital, Rome, and University of Pavia, Pavia, Italy; Ching-Hon Pui, St Jude Children's Research Hospital and University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Lewis B. Silverman, Dana-Faber Cancer Institute and Boston Children's Hospital, Boston, MA; Meenakshi Devidas, Children's Oncology Group Statistics and Data Center and University of Florida, Gainesville, FL; Martin Schrappe and Anja Moericke, University Medical Centre and Christian-Albrechts-University, Kiel; Gabriele Escherich, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Mervi Taskinen, Helsinki University Hospital, Helsinki, Finland; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, and Dutch Childhood Oncology Group, the Hague, the Netherlands; and Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Anja Moericke
- Ajay Vora, Sheffield Children's Hospital and University of Sheffield, Sheffield; Nicholas Goulden, Great Ormond Street Hospital, London, United Kingdom; Anita Andreano and Maria Grazia Valsecchi, School of Medicine and Surgery, University of Milano-Bicocca, Milan; Andrea Biondi, University of Milano-Bicocca, Monza; Franco Locatelli, Bambino Gesù Children's Hospital, Rome, and University of Pavia, Pavia, Italy; Ching-Hon Pui, St Jude Children's Research Hospital and University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Lewis B. Silverman, Dana-Faber Cancer Institute and Boston Children's Hospital, Boston, MA; Meenakshi Devidas, Children's Oncology Group Statistics and Data Center and University of Florida, Gainesville, FL; Martin Schrappe and Anja Moericke, University Medical Centre and Christian-Albrechts-University, Kiel; Gabriele Escherich, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Mervi Taskinen, Helsinki University Hospital, Helsinki, Finland; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, and Dutch Childhood Oncology Group, the Hague, the Netherlands; and Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Andrea Biondi
- Ajay Vora, Sheffield Children's Hospital and University of Sheffield, Sheffield; Nicholas Goulden, Great Ormond Street Hospital, London, United Kingdom; Anita Andreano and Maria Grazia Valsecchi, School of Medicine and Surgery, University of Milano-Bicocca, Milan; Andrea Biondi, University of Milano-Bicocca, Monza; Franco Locatelli, Bambino Gesù Children's Hospital, Rome, and University of Pavia, Pavia, Italy; Ching-Hon Pui, St Jude Children's Research Hospital and University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Lewis B. Silverman, Dana-Faber Cancer Institute and Boston Children's Hospital, Boston, MA; Meenakshi Devidas, Children's Oncology Group Statistics and Data Center and University of Florida, Gainesville, FL; Martin Schrappe and Anja Moericke, University Medical Centre and Christian-Albrechts-University, Kiel; Gabriele Escherich, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Mervi Taskinen, Helsinki University Hospital, Helsinki, Finland; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, and Dutch Childhood Oncology Group, the Hague, the Netherlands; and Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Gabriele Escherich
- Ajay Vora, Sheffield Children's Hospital and University of Sheffield, Sheffield; Nicholas Goulden, Great Ormond Street Hospital, London, United Kingdom; Anita Andreano and Maria Grazia Valsecchi, School of Medicine and Surgery, University of Milano-Bicocca, Milan; Andrea Biondi, University of Milano-Bicocca, Monza; Franco Locatelli, Bambino Gesù Children's Hospital, Rome, and University of Pavia, Pavia, Italy; Ching-Hon Pui, St Jude Children's Research Hospital and University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Lewis B. Silverman, Dana-Faber Cancer Institute and Boston Children's Hospital, Boston, MA; Meenakshi Devidas, Children's Oncology Group Statistics and Data Center and University of Florida, Gainesville, FL; Martin Schrappe and Anja Moericke, University Medical Centre and Christian-Albrechts-University, Kiel; Gabriele Escherich, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Mervi Taskinen, Helsinki University Hospital, Helsinki, Finland; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, and Dutch Childhood Oncology Group, the Hague, the Netherlands; and Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Lewis B Silverman
- Ajay Vora, Sheffield Children's Hospital and University of Sheffield, Sheffield; Nicholas Goulden, Great Ormond Street Hospital, London, United Kingdom; Anita Andreano and Maria Grazia Valsecchi, School of Medicine and Surgery, University of Milano-Bicocca, Milan; Andrea Biondi, University of Milano-Bicocca, Monza; Franco Locatelli, Bambino Gesù Children's Hospital, Rome, and University of Pavia, Pavia, Italy; Ching-Hon Pui, St Jude Children's Research Hospital and University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Lewis B. Silverman, Dana-Faber Cancer Institute and Boston Children's Hospital, Boston, MA; Meenakshi Devidas, Children's Oncology Group Statistics and Data Center and University of Florida, Gainesville, FL; Martin Schrappe and Anja Moericke, University Medical Centre and Christian-Albrechts-University, Kiel; Gabriele Escherich, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Mervi Taskinen, Helsinki University Hospital, Helsinki, Finland; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, and Dutch Childhood Oncology Group, the Hague, the Netherlands; and Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Nicholas Goulden
- Ajay Vora, Sheffield Children's Hospital and University of Sheffield, Sheffield; Nicholas Goulden, Great Ormond Street Hospital, London, United Kingdom; Anita Andreano and Maria Grazia Valsecchi, School of Medicine and Surgery, University of Milano-Bicocca, Milan; Andrea Biondi, University of Milano-Bicocca, Monza; Franco Locatelli, Bambino Gesù Children's Hospital, Rome, and University of Pavia, Pavia, Italy; Ching-Hon Pui, St Jude Children's Research Hospital and University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Lewis B. Silverman, Dana-Faber Cancer Institute and Boston Children's Hospital, Boston, MA; Meenakshi Devidas, Children's Oncology Group Statistics and Data Center and University of Florida, Gainesville, FL; Martin Schrappe and Anja Moericke, University Medical Centre and Christian-Albrechts-University, Kiel; Gabriele Escherich, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Mervi Taskinen, Helsinki University Hospital, Helsinki, Finland; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, and Dutch Childhood Oncology Group, the Hague, the Netherlands; and Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Mervi Taskinen
- Ajay Vora, Sheffield Children's Hospital and University of Sheffield, Sheffield; Nicholas Goulden, Great Ormond Street Hospital, London, United Kingdom; Anita Andreano and Maria Grazia Valsecchi, School of Medicine and Surgery, University of Milano-Bicocca, Milan; Andrea Biondi, University of Milano-Bicocca, Monza; Franco Locatelli, Bambino Gesù Children's Hospital, Rome, and University of Pavia, Pavia, Italy; Ching-Hon Pui, St Jude Children's Research Hospital and University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Lewis B. Silverman, Dana-Faber Cancer Institute and Boston Children's Hospital, Boston, MA; Meenakshi Devidas, Children's Oncology Group Statistics and Data Center and University of Florida, Gainesville, FL; Martin Schrappe and Anja Moericke, University Medical Centre and Christian-Albrechts-University, Kiel; Gabriele Escherich, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Mervi Taskinen, Helsinki University Hospital, Helsinki, Finland; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, and Dutch Childhood Oncology Group, the Hague, the Netherlands; and Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Rob Pieters
- Ajay Vora, Sheffield Children's Hospital and University of Sheffield, Sheffield; Nicholas Goulden, Great Ormond Street Hospital, London, United Kingdom; Anita Andreano and Maria Grazia Valsecchi, School of Medicine and Surgery, University of Milano-Bicocca, Milan; Andrea Biondi, University of Milano-Bicocca, Monza; Franco Locatelli, Bambino Gesù Children's Hospital, Rome, and University of Pavia, Pavia, Italy; Ching-Hon Pui, St Jude Children's Research Hospital and University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Lewis B. Silverman, Dana-Faber Cancer Institute and Boston Children's Hospital, Boston, MA; Meenakshi Devidas, Children's Oncology Group Statistics and Data Center and University of Florida, Gainesville, FL; Martin Schrappe and Anja Moericke, University Medical Centre and Christian-Albrechts-University, Kiel; Gabriele Escherich, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Mervi Taskinen, Helsinki University Hospital, Helsinki, Finland; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, and Dutch Childhood Oncology Group, the Hague, the Netherlands; and Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Keizo Horibe
- Ajay Vora, Sheffield Children's Hospital and University of Sheffield, Sheffield; Nicholas Goulden, Great Ormond Street Hospital, London, United Kingdom; Anita Andreano and Maria Grazia Valsecchi, School of Medicine and Surgery, University of Milano-Bicocca, Milan; Andrea Biondi, University of Milano-Bicocca, Monza; Franco Locatelli, Bambino Gesù Children's Hospital, Rome, and University of Pavia, Pavia, Italy; Ching-Hon Pui, St Jude Children's Research Hospital and University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Lewis B. Silverman, Dana-Faber Cancer Institute and Boston Children's Hospital, Boston, MA; Meenakshi Devidas, Children's Oncology Group Statistics and Data Center and University of Florida, Gainesville, FL; Martin Schrappe and Anja Moericke, University Medical Centre and Christian-Albrechts-University, Kiel; Gabriele Escherich, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Mervi Taskinen, Helsinki University Hospital, Helsinki, Finland; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, and Dutch Childhood Oncology Group, the Hague, the Netherlands; and Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Meenakshi Devidas
- Ajay Vora, Sheffield Children's Hospital and University of Sheffield, Sheffield; Nicholas Goulden, Great Ormond Street Hospital, London, United Kingdom; Anita Andreano and Maria Grazia Valsecchi, School of Medicine and Surgery, University of Milano-Bicocca, Milan; Andrea Biondi, University of Milano-Bicocca, Monza; Franco Locatelli, Bambino Gesù Children's Hospital, Rome, and University of Pavia, Pavia, Italy; Ching-Hon Pui, St Jude Children's Research Hospital and University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Lewis B. Silverman, Dana-Faber Cancer Institute and Boston Children's Hospital, Boston, MA; Meenakshi Devidas, Children's Oncology Group Statistics and Data Center and University of Florida, Gainesville, FL; Martin Schrappe and Anja Moericke, University Medical Centre and Christian-Albrechts-University, Kiel; Gabriele Escherich, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Mervi Taskinen, Helsinki University Hospital, Helsinki, Finland; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, and Dutch Childhood Oncology Group, the Hague, the Netherlands; and Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Franco Locatelli
- Ajay Vora, Sheffield Children's Hospital and University of Sheffield, Sheffield; Nicholas Goulden, Great Ormond Street Hospital, London, United Kingdom; Anita Andreano and Maria Grazia Valsecchi, School of Medicine and Surgery, University of Milano-Bicocca, Milan; Andrea Biondi, University of Milano-Bicocca, Monza; Franco Locatelli, Bambino Gesù Children's Hospital, Rome, and University of Pavia, Pavia, Italy; Ching-Hon Pui, St Jude Children's Research Hospital and University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Lewis B. Silverman, Dana-Faber Cancer Institute and Boston Children's Hospital, Boston, MA; Meenakshi Devidas, Children's Oncology Group Statistics and Data Center and University of Florida, Gainesville, FL; Martin Schrappe and Anja Moericke, University Medical Centre and Christian-Albrechts-University, Kiel; Gabriele Escherich, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Mervi Taskinen, Helsinki University Hospital, Helsinki, Finland; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, and Dutch Childhood Oncology Group, the Hague, the Netherlands; and Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Maria Grazia Valsecchi
- Ajay Vora, Sheffield Children's Hospital and University of Sheffield, Sheffield; Nicholas Goulden, Great Ormond Street Hospital, London, United Kingdom; Anita Andreano and Maria Grazia Valsecchi, School of Medicine and Surgery, University of Milano-Bicocca, Milan; Andrea Biondi, University of Milano-Bicocca, Monza; Franco Locatelli, Bambino Gesù Children's Hospital, Rome, and University of Pavia, Pavia, Italy; Ching-Hon Pui, St Jude Children's Research Hospital and University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Lewis B. Silverman, Dana-Faber Cancer Institute and Boston Children's Hospital, Boston, MA; Meenakshi Devidas, Children's Oncology Group Statistics and Data Center and University of Florida, Gainesville, FL; Martin Schrappe and Anja Moericke, University Medical Centre and Christian-Albrechts-University, Kiel; Gabriele Escherich, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Mervi Taskinen, Helsinki University Hospital, Helsinki, Finland; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, and Dutch Childhood Oncology Group, the Hague, the Netherlands; and Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
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Kim H. Recent advances in the treatment of pediatric acute leukemia. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2016. [DOI: 10.5124/jkma.2016.59.9.690] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Hyery Kim
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Integrative computational in-depth analysis of dysregulated miRNA-mRNA interactions in drug-resistant pediatric acute lymphoblastic leukemia cells: an attempt to obtain new potential gene-miRNA pathways involved in response to treatment. Tumour Biol 2015; 37:7861-72. [DOI: 10.1007/s13277-015-4553-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 11/30/2015] [Indexed: 12/28/2022] Open
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Lindemulder SJ, Stork LC, Bostrom B, Lu X, Devidas M, Hunger S, Neglia JP, Kadan-Lottick NS. Survivors of standard risk acute lymphoblastic leukemia do not have increased risk for overweight and obesity compared to non-cancer peers: a report from the Children's Oncology Group. Pediatr Blood Cancer 2015; 62:1035-41. [PMID: 25663378 PMCID: PMC4405430 DOI: 10.1002/pbc.25411] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 12/04/2014] [Indexed: 12/26/2022]
Abstract
BACKGROUND We sought to determine whether survivors of standard risk ALL (SR-ALL) treated without cranial radiation have increased risk for obesity by assessing changes in body mass index (BMI) during and after treatment; identifying contributing patient and treatment factors; comparing rates of overweight/obese to national health data. PROCEDURE Eligibility for this retrospective cohort study included: (i) previous enrollment on legacy therapy trials CCG1922 or CCG1952; (ii) continuous first remission; and (iii) age at follow-up evaluation of 6-16.99 years. Height and weight from diagnosis, consolidation, start of maintenance, last cycle of maintenance, and off-therapy were analyzed. RESULTS The 269 subjects were a median age of 3.5 years at diagnosis and 13.3 years at follow-up. BMI% significantly increased from induction to consolidation (+17.6 ± 1.6%), start of maintenance to end-of-treatment (+3.3 ± 1.6%) and decreased from end-of-treatment to follow-up (-3.5 ± 1.6%,). Higher BMI% at follow-up was associated with higher BMI% at diagnosis (P < 0.0001), but not age at diagnosis, gender, or race. Patients previously randomized to dexamethasone had a stronger association between BMI% at diagnosis and BMI% at follow-up than those who received prednisone (P = 0.0005). At follow-up, 39% of survivors were overweight or obese; the relative risk of overweight/obese was 1.028 (P = 0.738) compared to the general population. CONCLUSIONS Our study of patients with SR-ALL found a significant increase in BMI% largely during the first month of therapy that is greater with dexamethasone than prednisone. However, after therapy, there was no increased risk of overweight/obese BMI compared to non-cancer peers.
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Affiliation(s)
- Susan J Lindemulder
- Oregon Health & Science University, Doernbecher Children’s Hospital, Portland, OR
| | - Linda C Stork
- Oregon Health & Science University, Doernbecher Children’s Hospital, Portland, OR
| | - Bruce Bostrom
- Children’s Hospitals and Clinics of Minnesota, Minneapolis, MN
| | - Xiaomin Lu
- University of Florida, Department of Biostatistics, Colleges of Medicine, Public Health & Health Profession, Gainesville, FL
| | - Meenakshi Devidas
- University of Florida, Department of Biostatistics, Colleges of Medicine, Public Health & Health Profession, Gainesville, FL
| | - Stephen Hunger
- University of Colorado School of Medicine, University of Colorado Cancer Center, and Children’s Hospital, Aurora, CO
| | - Joseph P Neglia
- University of Minnesota Medical Center Fairview, Minneapolis, MN
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Jastaniah W, Elimam N, Abdalla K, Khattab TM, Felimban S, Abrar MB. Does the early intensification of intrathecal therapy improve outcomes in pediatric acute lymphoblastic leukemia patients with CNS2/TLP+ status at diagnosis? Hematology 2015; 20:561-6. [DOI: 10.1179/1607845415y.0000000020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Wasil Jastaniah
- Princess Noorah Oncology Center, King Saud Bin Abdulaziz University and King Abdulaziz Medical City, Jeddah, Saudi Arabia
- Department of Pediatrics, Faculty of Medicine, Umm AlQura University, Makkah, Saudi Arabia
| | - Naglla Elimam
- Princess Noorah Oncology Center, King Saud Bin Abdulaziz University and King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Khalid Abdalla
- Princess Noorah Oncology Center, King Saud Bin Abdulaziz University and King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Taha M. Khattab
- Princess Noorah Oncology Center, King Saud Bin Abdulaziz University and King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Sami Felimban
- Princess Noorah Oncology Center, King Saud Bin Abdulaziz University and King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Mohammed B. Abrar
- Princess Noorah Oncology Center, King Saud Bin Abdulaziz University and King Abdulaziz Medical City, Jeddah, Saudi Arabia
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Bassan R, Masciulli A, Intermesoli T, Audisio E, Rossi G, Pogliani EM, Cassibba V, Mattei D, Romani C, Cortelezzi A, Corti C, Scattolin AM, Spinelli O, Tosi M, Parolini M, Marmont F, Borlenghi E, Fumagalli M, Cortelazzo S, Gallamini A, Marfisi RM, Oldani E, Rambaldi A. Randomized trial of radiation-free central nervous system prophylaxis comparing intrathecal triple therapy with liposomal cytarabine in acute lymphoblastic leukemia. Haematologica 2015; 100:786-93. [PMID: 25749825 DOI: 10.3324/haematol.2014.123273] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 02/26/2015] [Indexed: 01/31/2023] Open
Abstract
Developing optimal radiation-free central nervous system prophylaxis is a desirable goal in acute lymphoblastic leukemia, to avoid the long-term toxicity associated with cranial irradiation. In a randomized, phase II trial enrolling 145 adult patients, we compared intrathecal liposomal cytarabine (50 mg: 6/8 injections in B-/T-cell subsets, respectively) with intrathecal triple therapy (methotrexate/cytarabine/prednisone: 12 injections). Systemic therapy included methotrexate plus cytarabine or L-asparaginase courses, with methotrexate augmented to 2.5 and 5 g/m(2) in Philadelphia-negative B- and T-cell disease, respectively. The primary study objective was the comparative assessment of the risk/benefit ratio, combining the analysis of feasibility, toxicity and efficacy. In the liposomal cytarabine arm 17/71 patients (24%) developed grade 3-4 neurotoxicity compared to 2/74 (3%) in the triple therapy arm (P=0.0002), the median number of episodes of neurotoxicity of any grade was one per patient compared to zero, respectively (P=0.0001), and even though no permanent disabilities or deaths were registered, four patients (6%) discontinued intrathecal prophylaxis on account of these toxic side effects (P=0.06). Neurotoxicity worsened with liposomal cytarabine every 14 days (T-cell disease), and was improved by the adjunct of intrathecal dexamethasone. Two patients in the liposomal cytarabine arm suffered from a meningeal relapse (none with T-cell disease, only one after high-dose chemotherapy) compared to four in the triple therapy arm (1 with T-cell disease). While intrathecal liposomal cytarabine could contribute to improved, radiation-free central nervous system prophylaxis, the toxicity reported in this trial does not support its use at 50 mg and prompts the investigation of a lower dosage. (clinicaltrials.gov identifier: NCT-00795756).
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Affiliation(s)
- Renato Bassan
- U.O.C. Ematologia, Ospedale dell'Angelo e Ospedale SS. Giovanni e Paolo, Mestre-Venezia
| | - Arianna Masciulli
- Laboratorio di Epidemiologia Clinica delle Malattie Cardiovascolari, Fondazione Mario Negri Sud, S.Maria Imbaro, Chieti
| | | | - Ernesta Audisio
- Ematologia 2, Presidio Ospedaliero Molinette, A.O.U. Città della Salute e della Scienza, Torino
| | | | | | | | - Daniele Mattei
- S.C. Ematologia, Azienda Ospedaliera S. Croce e Carle, Cuneo
| | - Claudio Romani
- U.O. Ematologia e Centro TMO, Ospedale Armando Businco, Cagliari
| | - Agostino Cortelezzi
- U.O. Ematologia e TMO, Fondazione IRCSS Cà Granda, Ospedale Maggiore Policlinico, Milano
| | | | - Anna Maria Scattolin
- U.O.C. Ematologia, Ospedale dell'Angelo e Ospedale SS. Giovanni e Paolo, Mestre-Venezia
| | - Orietta Spinelli
- U. O. C. Ematologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo
| | - Manuela Tosi
- U. O. C. Ematologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo
| | | | - Filippo Marmont
- Ematologia 2, Presidio Ospedaliero Molinette, A.O.U. Città della Salute e della Scienza, Torino
| | | | | | | | | | - Rosa Maria Marfisi
- Laboratorio di Epidemiologia Clinica delle Malattie Cardiovascolari, Fondazione Mario Negri Sud, S.Maria Imbaro, Chieti
| | - Elena Oldani
- U. O. C. Ematologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo
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Abstract
PURPOSE OF REVIEW In this article, new insights into the clinical and biological features of paediatric T-lineage acute lymphoblastic leukaemia (ALL) and their impact on treatment outcome have been described. RECENT FINDINGS T-lineage ALL has considerable phenotypic and biological heterogeneity. Compared with B-lineage ALL, the prognostic significance of the presenting white cell count is weaker and the rate of decline in minimal residual disease is slower in patients with T-lineage ALL. Contemporary, response stratified, treatment protocols incorporating dexamethasone have been associated with significant improvements in outcomes and demonstrated that cranial radiotherapy is not essential for preventing central nervous system relapse. Relapse risk remains higher than for B-lineage ALL and outcome after relapse is poor. Early T-precursor phenotype and genetic abnormalities such as activating ABL1 fusions, NOTCH1/FBXW7, and cytosolic 5'-nucleotidase II gene mutations identify patient groups who may benefit from alternative treatment. New agents such as nelarabine, bortezomib, and clofarabine may be effective in preventing unsalvageable relapses identified by slow response to first-line therapy. SUMMARY Around 85% of children and young people with T-lineage ALL are cured by current therapy. Further improvements in outcome can be expected from genetic profile and response-targeted therapeutics.
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Abstract
Acute lymphoblastic leukemia (ALL) is the most common pediatric oncologic diagnosis, and advances in its treatment have led to progressive improvements in survival. The 4 main components of therapy are remission induction, consolidation, maintenance, and central nervous system-directed therapy, and usually last 2 to 3 years. Treatment intensity based on risk-based stratification is the cornerstone of treatment. Patients with features of more favorable disease are spared the more toxic effects of chemotherapy, whereas more aggressive regimens are reserved for those with higher-risk disease. Prognosis of relapsed pediatric ALL depends primarily on duration of remission and site of relapse.
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Affiliation(s)
- Stacy L. Cooper
- Pediatric Hematology/Oncology, Johns Hopkins/National Institutes of Health, Bloomberg 11379, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Patrick A. Brown
- Pediatric Leukemia Program, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 1650 Orleans Street, CRB1 Room 2M49, Baltimore, MD 21231, USA,Corresponding author.
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Gassas A, Krueger J, Alvi S, Sung L, Hitzler J, Lieberman L. Diagnosis of central nervous system relapse of pediatric acute lymphoblastic leukemia: Impact of routine cytological CSF analysis at the time of intrathecal chemotherapy. Pediatr Blood Cancer 2014; 61:2215-7. [PMID: 25212396 DOI: 10.1002/pbc.25235] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 07/30/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND Despite the success of central nervous system (CNS) directed therapy in pediatric acute lymphoblastic leukemia (ALL), relapse involving the CNS continues to be observed in 5-10% of children when utilizing standard intrathecal prophylactic chemotherapy. While most pediatric ALL treatment protocols mandate regular lumbar punctures (LP) for the intrathecal injection of chemotherapy, the value of routine cytological analysis of cerebrospinal fluid (CSF) during therapy is unknown. Our objective was to assess the diagnostic value of routine CSF analysis during ALL therapy. PROCEDURE To allow for at least 10 years of follow up from ALL diagnosis, children (0-18 years) with ALL diagnosed and treated at SickKids, Toronto, Canada between 1994-2004 were studied. Medical records of patients with CNS relapse were examined to determine whether CNS relapse was diagnosed based on cytology of a routinely obtained CSF sample, a CSF sample obtained because of signs and symptoms or a CSF sample obtained after the diagnosis of a bone marrow relapse. RESULTS Of 494 children treated for ALL, 31 (6.6%) developed a relapse of ALL involving the CNS. Twenty-two had an isolated CNS relapse and nine had a combined bone marrow and CNS relapse. Among patients with isolated CNS relapse, 73% (16/22) were diagnosed based on routine CSF samples obtained from asymptomatic children. Conversely, 89% (8/9) of children with combined bone marrow and CNS relapse presented with symptoms and signs that prompted CSF examination. CONCLUSION Routine CSF examination at the time of LP for intrathecal chemotherapy is useful in detecting CNS relapse.
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Affiliation(s)
- Adam Gassas
- Division of Haematology/Oncology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Wray L, Vujkovic M, McWilliams T, Cannon S, Devidas M, Stork L, Aplenc R. TPMT and MTHFR genotype is not associated with altered risk of thioguanine-related sinusoidal obstruction syndrome in pediatric acute lymphoblastic leukemia: a report from the Children's Oncology Group. Pediatr Blood Cancer 2014; 61:2086-8. [PMID: 24737678 PMCID: PMC4283196 DOI: 10.1002/pbc.25057] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 03/18/2014] [Indexed: 11/10/2022]
Abstract
Sinusoidal obstruction syndrome is a complication of therapy for pediatric ALL and may be modified by thiopurine methyltransferase activity as well as by MTHFR genotype. We assessed TPMT *3A, *3B, *3C, and MTHFR C677T and A1298C germline genetic polymorphisms among 351 patients enrolled in the thioguanine treatment arm of CCG-1952 clinical trial. TPMT and MTHFR C677T genotypes were not associated with SOS risk. The combination of MTHFR and TPMT variant genotypes was not associated with SOS risk. These suggest that germline genetic variation in TPMT and MTHFR do not significantly alter SOS risk in patients exposed to thioguanine.
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Affiliation(s)
- Lisa Wray
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Marijana Vujkovic
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Correspondence to: Dr. M. Vujkovic, Children’s Hospital of Philadelphia, 4200 CTRB, 3501 Civic Center Boulevard, Philadelphia, PA 19104.
| | - Thomas McWilliams
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Shannon Cannon
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Meenakshi Devidas
- Department of Biostatistics, Colleges of Medicine and Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Linda Stork
- Division of Hematology-Oncology, Doernbecher Children’s Hospital/Oregon Health & Science University, Portland, Oregon
| | - Richard Aplenc
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
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Liu HC, Yeh TC, Hou JY, Chen KH, Huang TH, Chang CY, Liang DC. Triple Intrathecal Therapy Alone With Omission of Cranial Radiation in Children With Acute Lymphoblastic Leukemia. J Clin Oncol 2014; 32:1825-9. [DOI: 10.1200/jco.2013.54.5020] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To eliminate the toxicities and sequelae of cranial irradiation (CrRT) and to minimize the adverse impact of traumatic lumbar puncture (TLP) with blasts, a prospective study of a modified CNS-directed therapy was conducted in children with acute lymphoblastic leukemia (ALL). Patients and Methods Since June 1999, children with newly diagnosed ALL have been treated with triple intrathecal therapy (TIT) alone without CrRT. The first TIT was delayed until the disappearance of blasts from peripheral blood (PB) for up to 10 days of multidrug induction, and CrRT was omitted in all patients. If PB blasts persisted on treatment day 10 (d10), the TIT was then performed. Results Of a total of 156 patients, 152 were eligible. Seventeen patients did not have PB blasts at diagnosis. Three fourths of the remaining patients achieved complete clearance of PB blasts by d10. Only hyperleukocytosis at diagnosis showed a significantly lower clearance rate. Six standard-risk patients were upgraded to high risk because of detectable PB blasts on d10. TLPs were encountered in four patients (2.6%), but none were contaminated with lymphoblasts. Neither CNS-2 (less than 5 WBCs/μL with blasts in a nontraumatic sample) nor CNS-3 (≥ 5 WBCs/μL with blasts in a nontraumatic sample or the presence of cranial nerve palsy) was present. The 5-year event-free survival and overall survival rates ± SE were 84.2% ± 3.0% and 90.6% ± 2.4%, respectively. No isolated CNS relapse occurred, but two patients experienced combined CNS relapses. The 7-year cumulative risk of any CNS relapse was 1.4% ± 1.0%. Conclusion Delaying first TIT until circulating blasts have cleared may improve CNS control in children with newly diagnosed ALL and preclude the need for CrRT.
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Affiliation(s)
- Hsi-Che Liu
- Hsi-Che Liu, Ting-Chi Yeh, Jen-Yin Hou, and Der-Cherng Liang, Mackay Medical College, New Taipei; and Hsi-Che Liu, Ting-Chi Yeh, Jen-Yin Hou, Kuan-Hao Chen, Ting-Huan Huang, Ching-Yi Chang, and Der-Cherng Liang, Mackay Memorial Hospital, Taipei, Taiwan
| | - Ting-Chi Yeh
- Hsi-Che Liu, Ting-Chi Yeh, Jen-Yin Hou, and Der-Cherng Liang, Mackay Medical College, New Taipei; and Hsi-Che Liu, Ting-Chi Yeh, Jen-Yin Hou, Kuan-Hao Chen, Ting-Huan Huang, Ching-Yi Chang, and Der-Cherng Liang, Mackay Memorial Hospital, Taipei, Taiwan
| | - Jen-Yin Hou
- Hsi-Che Liu, Ting-Chi Yeh, Jen-Yin Hou, and Der-Cherng Liang, Mackay Medical College, New Taipei; and Hsi-Che Liu, Ting-Chi Yeh, Jen-Yin Hou, Kuan-Hao Chen, Ting-Huan Huang, Ching-Yi Chang, and Der-Cherng Liang, Mackay Memorial Hospital, Taipei, Taiwan
| | - Kuan-Hao Chen
- Hsi-Che Liu, Ting-Chi Yeh, Jen-Yin Hou, and Der-Cherng Liang, Mackay Medical College, New Taipei; and Hsi-Che Liu, Ting-Chi Yeh, Jen-Yin Hou, Kuan-Hao Chen, Ting-Huan Huang, Ching-Yi Chang, and Der-Cherng Liang, Mackay Memorial Hospital, Taipei, Taiwan
| | - Ting-Huan Huang
- Hsi-Che Liu, Ting-Chi Yeh, Jen-Yin Hou, and Der-Cherng Liang, Mackay Medical College, New Taipei; and Hsi-Che Liu, Ting-Chi Yeh, Jen-Yin Hou, Kuan-Hao Chen, Ting-Huan Huang, Ching-Yi Chang, and Der-Cherng Liang, Mackay Memorial Hospital, Taipei, Taiwan
| | - Ching-Yi Chang
- Hsi-Che Liu, Ting-Chi Yeh, Jen-Yin Hou, and Der-Cherng Liang, Mackay Medical College, New Taipei; and Hsi-Che Liu, Ting-Chi Yeh, Jen-Yin Hou, Kuan-Hao Chen, Ting-Huan Huang, Ching-Yi Chang, and Der-Cherng Liang, Mackay Memorial Hospital, Taipei, Taiwan
| | - Der-Cherng Liang
- Hsi-Che Liu, Ting-Chi Yeh, Jen-Yin Hou, and Der-Cherng Liang, Mackay Medical College, New Taipei; and Hsi-Che Liu, Ting-Chi Yeh, Jen-Yin Hou, Kuan-Hao Chen, Ting-Huan Huang, Ching-Yi Chang, and Der-Cherng Liang, Mackay Memorial Hospital, Taipei, Taiwan
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Abstract
The 50th anniversary of Seminars in Hematology coincides with the 50th anniversary of St. Jude Children's Research Hospital, and both milestones are inexorably linked to studies contributing to the cure of childhood acute lymphoblastic leukemia (ALL). We thought it fitting, therefore, to mark these events by traveling back in time to point out some of the achievements, institutions, study groups, and individuals that have made cure of childhood ALL a reality. In many instances, progress was driven by new ideas, while in others it was driven by new experimental tools that allowed more precise assessment of the biology of leukemic blasts and their utility in selecting therapy. We also discuss a number of contemporary advances that point the way to exciting future directions. Whatever pathways are taken, a clear challenge will be to use emerging genome-based or immunologic-based treatment options in ways that will enhance, rather than duplicate or compromise, recent gains in outcome with classic cytotoxic chemotherapy. The theme of this journey serves as a reminder of the chief ingredient of any research directed to a catastrophic disease such as ALL. It is the audacity of a small group of investigators who confronted a childhood cancer with the goal of cure, not palliation, as their mindset.
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Affiliation(s)
- Ching-Hon Pui
- Departments of Oncology and Pharmaceutical Sciences, St. Jude Children's Research Hospital.
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50
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Kunin-Batson A, Kadan-Lottick N, Neglia JP. The contribution of neurocognitive functioning to quality of life after childhood acute lymphoblastic leukemia. Psychooncology 2014; 23:692-9. [DOI: 10.1002/pon.3470] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 11/12/2013] [Accepted: 12/02/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Alicia Kunin-Batson
- HealthPartners Institute for Education and Research; Minneapolis MN USA
- University of Minnesota Medical School; Minneapolis MN USA
| | - Nina Kadan-Lottick
- Yale University School of Medicine and Yale Cancer Center; New Haven CT USA
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