1
|
Lopez-Cortes A, Didonè F, Botta L, Hjalgrim LL, Jakab Z, Cañete Nieto A, Stiller C, Zeller B, Gatta G, Pritchard-Jones K. Corrigendum: Cancer data quality and harmonization in Europe: The experience of the BENCHISTA Project - International Benchmarking of Childhood Cancer Survival by Stage. Front Oncol 2024; 14:1397101. [PMID: 38606092 PMCID: PMC11007700 DOI: 10.3389/fonc.2024.1397101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 03/18/2024] [Indexed: 04/13/2024] Open
Abstract
[This corrects the article DOI: 10.3389/fonc.2023.1232451.].
Collapse
Affiliation(s)
- Angela Lopez-Cortes
- University College London (UCL) Great Ormond Street Institute of Child Health, Developmental Biology & Cancer Research Department, London, United Kingdom
| | - Fabio Didonè
- Fondazione IRCCS “Istituto Nazionale dei Tumori di Milano” (INT), Department of Evaluative Epidemiology, Milan, Italy
| | - Laura Botta
- Fondazione IRCCS “Istituto Nazionale dei Tumori di Milano” (INT), Department of Evaluative Epidemiology, Milan, Italy
| | | | | | | | | | | | - Gemma Gatta
- Fondazione IRCCS “Istituto Nazionale dei Tumori di Milano” (INT), Department of Evaluative Epidemiology, Milan, Italy
| | - Kathy Pritchard-Jones
- University College London (UCL) Great Ormond Street Institute of Child Health, Developmental Biology & Cancer Research Department, London, United Kingdom
| | | |
Collapse
|
2
|
Lopez-Cortes A, Didonè F, Botta L, Hjalgrim LL, Jakab Z, Cañete Nieto A, Stiller C, Zeller B, Gatta G, Pritchard-Jones K. Cancer data quality and harmonization in Europe: the experience of the BENCHISTA Project - international benchmarking of childhood cancer survival by stage. Front Oncol 2023; 13:1232451. [PMID: 37675230 PMCID: PMC10477775 DOI: 10.3389/fonc.2023.1232451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/24/2023] [Indexed: 09/08/2023] Open
Abstract
Introduction Variation in stage at diagnosis of childhood cancers (CC) may explain differences in survival rates observed across geographical regions. The BENCHISTA project aims to understand these differences and to encourage the application of the Toronto Staging Guidelines (TG) by Population-Based Cancer Registries (PBCRs) to the most common solid paediatric cancers. Methods PBCRs within and outside Europe were invited to participate and identify all cases of Neuroblastoma, Wilms Tumour, Medulloblastoma, Ewing Sarcoma, Rhabdomyosarcoma and Osteosarcoma diagnosed in a consecutive three-year period (2014-2017) and apply TG at diagnosis. Other non-stage prognostic factors, treatment, progression/recurrence, and cause of death information were collected as optional variables. A minimum of three-year follow-up was required. To standardise TG application by PBCRs, on-line workshops led by six tumour-specific clinical experts were held. To understand the role of data availability and quality, a survey focused on data collection/sharing processes and a quality assurance exercise were generated. To support data harmonization and query resolution a dedicated email and a question-and-answers bank were created. Results 67 PBCRs from 28 countries participated and provided a maximally de-personalized, patient-level dataset. For 26 PBCRs, data format and ethical approval obtained by the two sponsoring institutions (UCL and INT) was sufficient for data sharing. 41 participating PBCRs required a Data Transfer Agreement (DTA) to comply with data protection regulations. Due to heterogeneity found in legal aspects, 18 months were spent on finalizing the DTA. The data collection survey was answered by 68 respondents from 63 PBCRs; 44% of them confirmed the ability to re-consult a clinician in cases where stage ascertainment was difficult/uncertain. Of the total participating PBCRs, 75% completed the staging quality assurance exercise, with a median correct answer proportion of 92% [range: 70% (rhabdomyosarcoma) to 100% (Wilms tumour)]. Conclusion Differences in interpretation and processes required to harmonize general data protection regulations across countries were encountered causing delays in data transfer. Despite challenges, the BENCHISTA Project has established a large collaboration between PBCRs and clinicians to collect detailed and standardised TG at a population-level enhancing the understanding of the reasons for variation in overall survival rates for CC, stimulate research and improve national/regional child health plans.
Collapse
Affiliation(s)
- Angela Lopez-Cortes
- University College London (UCL) Great Ormond Street Institute of Child Health, Developmental Biology & Cancer Research Department, London, United Kingdom
| | - Fabio Didonè
- Fondazione IRCCS “Istituto Nazionale dei Tumori di Milano” (INT), Department of Evaluative Epidemiology, Milan, Italy
| | - Laura Botta
- Fondazione IRCCS “Istituto Nazionale dei Tumori di Milano” (INT), Department of Evaluative Epidemiology, Milan, Italy
| | | | | | | | | | | | - Gemma Gatta
- Fondazione IRCCS “Istituto Nazionale dei Tumori di Milano” (INT), Department of Evaluative Epidemiology, Milan, Italy
| | - Kathy Pritchard-Jones
- University College London (UCL) Great Ormond Street Institute of Child Health, Developmental Biology & Cancer Research Department, London, United Kingdom
| |
Collapse
|
3
|
Mauz-Körholz C, Landman-Parker J, Fernández-Teijeiro A, Attarbaschi A, Balwierz W, Bartelt JM, Beishuizen A, Boudjemaa S, Cepelova M, Ceppi F, Claviez A, Daw S, Dieckmann K, Fosså A, Gattenlöhner S, Georgi T, Hjalgrim LL, Hraskova A, Karlén J, Kurch L, Leblanc T, Mann G, Montravers F, Pears J, Pelz T, Rajić V, Ramsay AD, Stoevesandt D, Uyttebroeck A, Vordermark D, Körholz D, Hasenclever D, Wallace WH, Kluge R. Response-adapted omission of radiotherapy in children and adolescents with early-stage classical Hodgkin lymphoma and an adequate response to vincristine, etoposide, prednisone, and doxorubicin (EuroNet-PHL-C1): a titration study. Lancet Oncol 2023; 24:252-261. [PMID: 36858722 DOI: 10.1016/s1470-2045(23)00019-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/10/2023] [Accepted: 01/16/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Children and adolescents with early-stage classical Hodgkin lymphoma have a 5-year event-free survival of 90% or more with vincristine, etoposide, prednisone, and doxorubicin (OEPA) plus radiotherapy, but late complications of treatment affect survival and quality of life. We investigated whether radiotherapy can be omitted in patients with adequate morphological and metabolic responses to OEPA. METHODS The EuroNet-PHL-C1 trial was designed as a titration study and recruited patients at 186 hospital sites across 16 European countries. Children and adolescents with newly diagnosed stage IA, IB, and IIA classical Hodgkin lymphoma younger than 18 years of age were assigned to treatment group 1 to be treated with two cycles of OEPA (vincristine 1·5 mg/m2 intravenously, capped at 2 mg, on days 1, 8, and 15; etoposide 125 mg/m2 intravenously, on days 1-5; prednisone 60 mg/m2 orally on days 1-15; and doxorubicin 40 mg/m2 intravenously on days 1 and 15). If no adequate response (a partial morphological remission or greater and PET negativity) had been achieved after two cycles of OEPA, involved-field radiotherapy was administered at a total dose of 19·8 Gy (usually in 11 fractions of 1·8 Gy per day). The primary endpoint was event-free survival. The primary objective was maintaining a 5-year event-free survival rate of 90% in patients with an adequate response to OEPA without radiotherapy. We performed intention-to-treat and per-protocol analyses. The trial was registered at ClinicalTrials.gov (NCT00433459) and with EUDRACT, (2006-000995-33) and is completed. FINDINGS Between Jan 31, 2007, and Jan 30, 2013, 2131 patients were registered and 2102 patients were enrolled onto EuroNet-PHL-C1. Of these 2102 patients, 738 with early-stage disease were allocated to treatment group 1. Median follow-up was 63·3 months (IQR 60·1-69·8). We report on 714 patients assigned to and treated on treatment group 1; the intention-to-treat population comprised 713 patients with 323 (45%) male and 390 (55%) female patients. In 440 of 713 patients in the intention-to-treat group who had an adequate response and did not receive radiotherapy, 5-year event-free survival was 86·5% (95% CI 83·3-89·8), which was less than the 90% target rate. In 273 patients with an inadequate response who received radiotherapy, 5-year event-free survival was 88·6% (95% CI 84·8-92·5), for which the 95% CI included the 90% target rate. The most common grade 3-4 adverse events were neutropenia (in 597 [88%] of 680 patients) and leukopenia (437 [61%] of 712). There were no treatment-related deaths. INTERPRETATION On the basis of all the evidence, radiotherapy could be omitted in patients with early-stage classical Hodgkin lymphoma and an adequate response to OEPA, but patients with risk factors might need more intensive treatment. FUNDING Deutsche Krebshilfe, Elternverein für Krebs-und leukämiekranke Kinder, Gießen, Kinderkrebsstiftung Mainz of the Journal Oldtimer Markt, Tour der Hoffnung, Menschen für Kinder, Mitteldeutsche Kinderkrebsforschung, Programme Hospitalier de Recherche Clinique, and Cancer Research UK.
Collapse
Affiliation(s)
| | - Judith Landman-Parker
- Department of Paediatric Haematology-Oncology, Sorbonne Université and Assistance Publique des Hopitaux de Paris, Hôpital a Trousseau, Paris, France
| | | | - Andishe Attarbaschi
- Department of Paediatric Haematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Walentyna Balwierz
- Department of Paediatric Oncology and Haematology, Institute of Paediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Jörg M Bartelt
- Department of Radiology, University Hospital Halle, Halle, Germany
| | - Auke Beishuizen
- Princess Máxima Centre for Paediatric Oncology, Utrecht and Erasmus, Sophia Children's Hospital, Rotterdam, Netherlands
| | - Sabah Boudjemaa
- Department of Pathology, Armand Trousseau Hospital, Paris, France
| | - Michaela Cepelova
- Department of Paediatric Haematology and Oncology, University Hospital Motol, Prague, Czech Republic
| | - Francesco Ceppi
- Pediatric Hematology-Oncology Unit, Division of Pediatrics, Department Woman-Mother-Child, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Alexander Claviez
- Department of Paediatrics, University of Schleswig-Holstein, Kiel, Germany
| | - Stephen Daw
- Children and Young People's Cancer Service, University College Hospital London, London, UK
| | - Karin Dieckmann
- Strahlentherapie Allgemeines Krankenhaus Wien, Medizinische Universitätsklinik Wien, Vienna, Austria
| | | | | | - Thomas Georgi
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Lisa L Hjalgrim
- Department of Paediatrics and Adolescent Medicine, The Juliane Marie Centre, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Andrea Hraskova
- Department of Paediatric Haematology and Oncology, National Institute of Children's Disease and Comenius University, Bratislava, Slovakia
| | - Jonas Karlén
- Department of Paediatric Oncology at Astrid Lindgrens Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Kurch
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Thierry Leblanc
- Service d'Hématologie Pédiatrique, Hôpital Robert-Debré, Paris, France
| | - Georg Mann
- St Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Francoise Montravers
- Department of Nuclear Medicine, Tenon Hospital, APHP and Sorbonne Université, Paris, France
| | - Jane Pears
- Our Lady's Hospital for Children's Health, Dublin, Ireland
| | - Tanja Pelz
- Medical Faculty (Prof C Mauz-Körholz) and Department of Radiation Oncology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Vladan Rajić
- Clinical Department of Paediatric Haematology, Oncology, and Stem Cell Transplantation, University Medical Centre Ljubljana and University Children's Hospital, Ljubljana, Slovenia
| | - Alan D Ramsay
- Department of Cellular Pathology, University College Hospital London, London, UK
| | | | - Anne Uyttebroeck
- Paediatric Haematology and Oncology, Department of Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Dirk Vordermark
- Medical Faculty (Prof C Mauz-Körholz) and Department of Radiation Oncology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Dieter Körholz
- Department of Paediatric Oncology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Dirk Hasenclever
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - William H Wallace
- Department of Paediatric Haematology and Oncology, Royal Hospital for Children and Young People, University of Edinburgh, Edinburgh, UK.
| | - Regine Kluge
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| |
Collapse
|
4
|
Rechner LA, Maraldo MV, Smith EAK, Lundgaard AY, Hjalgrim LL, MacKay RI, Aitkenhead AH, Aznar MC. Proton linear energy transfer and variable relative biological effectiveness for adolescent patients with Hodgkin lymphoma. BJR Open 2023; 5:20230012. [PMID: 37035769 PMCID: PMC10077416 DOI: 10.1259/bjro.20230012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 02/08/2023] Open
Abstract
Objectives: Proton therapy has a theoretical dosimetric advantage due to the Bragg peak, but the linear energy transfer (LET), and therefore the relative biological effectiveness (RBE), increase at the end of range. For patients with Hodgkin lymphoma, the distal edge of beam is often located within or close to the heart, where elevated RBE would be of potential concern. The purpose of this study was to investigate the impact of RBE and the choice of beam arrangement for adolescent patients with mediastinal Hodgkin lymphoma. Methods: For three previously treated adolescent patients, proton plans with 1–3 fields were created to a prescribed dose of 19.8 Gy (RBE) in 11 fractions (Varian Eclipse v13.7), assuming an RBE of 1.1. Plans were recalculated using Monte-Carlo (Geant4 v10.3.3/Gate v8.1) to calculate dose-averaged LET. Variable RBE-weighted dose was calculated using the McNamara model, assuming an α/β ratio of 2 Gy for organs-at-risk. Results: Although the LET decreased as the number of fields increased, the difference in RBE-weighted dose (Δdose) to organs-at-risk did not consistently decrease. Δdose values varied by patient and organ and were mostly of the order of 0–3 Gy (RBE), with a worst-case of 4.75 Gy (RBE) in near-maximum dose to the left atrium for one plan. Conclusions: RBE-weighted doses to organs-at-risk are sensitive to the choice of RBE model, which is of particular concern for the heart. Advances in knowledge: There is a need to remain cautious when evaluating proton plans for Hodgkin lymphoma, especially when near-maximum doses to organs-at-risk are considered.
Collapse
Affiliation(s)
- Laura Ann Rechner
- Department of Oncology, Rigshospitalet, Copenhagen, DK
- Niels Bohr Institute, University of Copenhagen, Copenhagen, DK
| | | | - Edward AK Smith
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | | | - Lisa L. Hjalgrim
- Department of Pediatric Hematology and Oncology, Rigshospitalet, Copenhagen, DK
| | - Ranald I. MacKay
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - Adam H. Aitkenhead
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - Marianne C. Aznar
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, England, United Kingdom
| |
Collapse
|
5
|
Smith L, Stiller CA, Aitken JF, Hjalgrim LL, Johannesen T, Lahteenmaki P, McCabe MG, Phillips R, Pritchard-Jones K, Steliarova-Foucher E, Winther JF, Woods RR, Glaser AW, Feltbower RG. International variation in childhood cancer mortality rates from 2001 to 2015: Comparison of trends in the International Cancer Benchmarking Partnership countries. Int J Cancer 2022; 150:28-37. [PMID: 34449879 DOI: 10.1002/ijc.33774] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/14/2021] [Accepted: 07/21/2021] [Indexed: 11/10/2022]
Abstract
Despite improved survival rates, cancer remains one of the most common causes of childhood death. The International Cancer Benchmarking Partnership (ICBP) showed variation in cancer survival for adults. We aimed to assess and compare trends over time in cancer mortality between children, adolescents and young adults (AYAs) and adults in the six countries involved in the ICBP: United Kingdom, Denmark, Australia, Canada, Norway and Sweden. Trends in mortality between 2001 and 2015 in the six original ICBP countries were examined. Age standardised mortality rates (ASR per million) were calculated for all cancers, leukaemia, malignant and benign central nervous system (CNS) tumours, and non-CNS solid tumours. ASRs were reported for children (age 0-14 years), AYAs aged 15 to 39 years and adults aged 40 years and above. Average annual percentage change (AAPC) in mortality rates per country were estimated using Joinpoint regression. For all cancers combined, significant temporal reductions were observed in all countries and all age groups. However, the overall AAPC was greater for children (-2.9; 95% confidence interval = -4.0 to -1.7) compared to AYAs (-1.8; -2.1 to -1.5) and adults aged >40 years (-1.5; -1.6 to -1.4). This pattern was mirrored for leukaemia, CNS tumours and non-CNS solid tumours, with the difference being most pronounced for leukaemia: AAPC for children -4.6 (-6.1 to -3.1) vs AYAs -3.2 (-4.2 to -2.1) and over 40s -1.1 (-1.3 to -0.8). AAPCs varied between countries in children for all cancers except leukaemia, and in adults over 40 for all cancers combined, but not in subgroups. Improvements in cancer mortality rates in ICBP countries have been most marked among children aged 0 to 14 in comparison to 15 to 39 and over 40 year olds. This may reflect better care, including centralised service provision, treatment protocols and higher trial recruitment rates in children compared to older patients.
Collapse
Affiliation(s)
- Lesley Smith
- Leeds Institute for Data Analytics, School of Medicine, University of Leeds, Leeds, UK
| | - Charles A Stiller
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Joanne F Aitken
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- Cancer Council Queensland, Brisbane, Queensland, Australia
| | - Lisa L Hjalgrim
- Department of Pediatric Hematology/Oncology, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Tom Johannesen
- Registry Department, Norwegian Cancer Registry, Oslo, Norway
| | - Paivi Lahteenmaki
- Swedish Childhood Cancer Registry, Karolinska Institute, Stockholm, Sweden
- Department of Pediatric and Adolecent Medicine, University of Turku, Turku, Finland
| | - Martin G McCabe
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Robert Phillips
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Kathy Pritchard-Jones
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | | | - Jeanette F Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, Aarhus, Denmark
| | - Ryan R Woods
- BC Cancer Research Centre, Vancouver, British Columbia, Canada
- Faculty of Heath Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Adam W Glaser
- Leeds Institute for Data Analytics, School of Medicine, University of Leeds, Leeds, UK
- Leeds Institute of Medical Research at St James's, School of Medicine, University of Leeds, Leeds, UK
| | - Richard G Feltbower
- Leeds Institute for Data Analytics, School of Medicine, University of Leeds, Leeds, UK
| |
Collapse
|
6
|
Toksvang LN, Grell K, Nersting J, Degn M, Nielsen SN, Abrahamsson J, Lund B, Kanerva J, Jónsson ÓG, Lepik K, Vaitkevičienė G, Griškevičius L, Quist-Paulsen P, Vora A, Moorman AV, Murdy D, Zimmermann M, Möricke A, Bostrom B, Joshi J, Hjalgrim LL, Dalhoff KP, Als-Nielsen B, Schmiegelow K. DNA-thioguanine concentration and relapse risk in children and young adults with acute lymphoblastic leukemia: an IPD meta-analysis. Leukemia 2022; 36:33-41. [PMID: 34175901 DOI: 10.1038/s41375-021-01182-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 01/11/2021] [Accepted: 02/02/2021] [Indexed: 12/17/2022]
Abstract
Methotrexate/6-mercaptopurine maintenance therapy improves acute lymphoblastic leukemia (ALL) outcome. Cytotoxicity is mediated by DNA incorporation of thioguanine nucleotides (DNA-TG). We investigated the association of DNA-TG to relapse risk in 1 910 children and young adults with non-high risk ALL. In a cohort-stratified Cox regression analysis adjusted for sex, age, and white cell count at diagnosis, the relapse-specific hazard ratio (HRa) per 100 fmol/μg increase in weighted mean DNA-TG (wmDNA-TG) was 0.87 (95% CI 0.78-0.97; p = 0.013) in the 839 patients who were minimal residual disease (MRD) positive at end of induction therapy (EOI), whereas this was not the case in EOI MRD-negative patients (p = 0.76). Validation analysis excluding the previously published Nordic NOPHO ALL2008 pediatric cohort yielded a HRa of 0.92 (95% CI 0.82-1.03; p = 0.15) per 100 fmol/μg increase in wmDNA-TG in EOI MRD-positive patients. If also excluding the United Kingdom cohort, in which samples were taken non-randomly in selected patients, the HRa for the EOI MRD-positive patients was 0.82 (95% CI 0.68-0.99; p = 0.044) per 100 fmol/μg increase in wmDNA-TG. The importance of DNA-TG as a biomarker for maintenance therapy intensity calls for novel strategies to increase DNA-TG, although its clinical value may vary by protocol backbone.
Collapse
Affiliation(s)
| | - Kathrine Grell
- Rigshospitalet, Copenhagen, Denmark
- University of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | - Bendik Lund
- St Olavs Hospital, Trondheim, Norway
- Norwegian University of Science and Technology, Trondheim, Norway
| | - Jukka Kanerva
- Helsinki Central Hospital and University of Helsinki, Helsinki, Finland
| | | | | | - Goda Vaitkevičienė
- Center for Pediatric Oncology and Hematology, Vilnius University, Vilnius, Lithuania
| | - Laimonas Griškevičius
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
- Vilnius University, Vilnius, Lithuania
| | | | - Ajay Vora
- Great Ormond Street Hospital for Children National Health Service Trust, London, United Kingdom
| | - Anthony V Moorman
- Leukaemia Research Cytogenetics Group, Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Daniel Murdy
- Leukaemia Research Cytogenetics Group, Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | | | - Anja Möricke
- University Hospital Schleswig-Holstein, Kiel, Germany
| | - Bruce Bostrom
- Children's Hospital and Clinics of Minnesota, Minneapolis, MI, USA
| | - Jaitri Joshi
- Children's Hospital and Clinics of Minnesota, Minneapolis, MI, USA
| | | | - Kim P Dalhoff
- University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | | | - Kjeld Schmiegelow
- Rigshospitalet, Copenhagen, Denmark.
- University of Copenhagen, Copenhagen, Denmark.
| |
Collapse
|
7
|
Mauz-Körholz C, Landman-Parker J, Balwierz W, Ammann RA, Anderson RA, Attarbaschi A, Bartelt JM, Beishuizen A, Boudjemaa S, Cepelova M, Claviez A, Daw S, Dieckmann K, Fernández-Teijeiro A, Fosså A, Gattenlöhner S, Georgi T, Hjalgrim LL, Hraskova A, Karlén J, Kluge R, Kurch L, Leblanc T, Mann G, Montravers F, Pears J, Pelz T, Rajić V, Ramsay AD, Stoevesandt D, Uyttebroeck A, Vordermark D, Körholz D, Hasenclever D, Wallace WH. Response-adapted omission of radiotherapy and comparison of consolidation chemotherapy in children and adolescents with intermediate-stage and advanced-stage classical Hodgkin lymphoma (EuroNet-PHL-C1): a titration study with an open-label, embedded, multinational, non-inferiority, randomised controlled trial. Lancet Oncol 2022; 23:125-137. [PMID: 34895479 PMCID: PMC8716340 DOI: 10.1016/s1470-2045(21)00470-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 08/02/2021] [Accepted: 08/05/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Children and adolescents with intermediate-stage and advanced-stage classical Hodgkin lymphoma achieve an event-free survival at 5 years of about 90% after treatment with vincristine, etoposide, prednisone, and doxorubicin (OEPA) followed by cyclophosphamide, vincristine, prednisone, and procarbazine (COPP) and radiotherapy, but long-term treatment effects affect survival and quality of life. We aimed to investigate whether radiotherapy can be omitted in patients with morphological and metabolic adequate response to OEPA and whether modified consolidation chemotherapy reduces gonadotoxicity. METHODS Our study was designed as a titration study with an open-label, embedded, multinational, non-inferiority, randomised controlled trial, and was carried out at 186 hospital sites across 16 European countries. Children and adolescents with newly diagnosed intermediate-stage (treatment group 2) and advanced-stage (treatment group 3) classical Hodgkin lymphoma who were younger than 18 years and stratified according to risk using Ann Arbor disease stages IIAE, IIB, IIBE, IIIA, IIIAE, IIIB, IIIBE, and all stages IV (A, B, AE, and BE) were included in the study. Patients with early disease (treatment group 1) were excluded from this analysis. All patients were treated with two cycles of OEPA (1·5 mg/m2 vincristine taken intravenously capped at 2 mg, on days 1, 8, and 15; 125 mg/m2 etoposide taken intravenously on days 1-5; 60 mg/m2 prednisone taken orally on days 1-15; and 40 mg/m2 doxorubicin taken intravenously on days 1 and 15). Patients were randomly assigned to two (treatment group 2) or four (treatment group 3) cycles of COPP (500 mg/m2 cyclophosphamide taken intravenously on days 1 and 8; 1·5 mg/m2 vincristine taken intravenously capped at 2 mg, on days 1 and 8; 40 mg/m2 prednisone taken orally on days 1 to 15; and 100 mg/m2 procarbazine taken orally on days 1 to 15) or COPDAC, which was identical to COPP except that 250 mg/m2 dacarbazine administered intravenously on days 1 to 3 replaced procarbazine. The method of randomisation (1:1) was minimisation with stochastic component and was centrally stratified by treatment group, country, trial sites, and sex. The primary endpoint was event-free survival, defined as time from treatment start until the first of the following events: death from any cause, progression or relapse of classical Hodgkin lymphoma, or occurrence of secondary malignancy. The primary objectives were maintaining 90% event-free survival at 5 years in patients with adequate response to OEPA treated without radiotherapy and to exclude a decrease of 8% in event-free survival at 5 years in the embedded COPDAC versus COPP randomisation to show non-inferiority of COPDAC. Efficacy analyses are reported per protocol and safety in the intention-to-treat population. The trial is registered with ClinicalTrials.gov (trial number NCT00433459) and EUDRACT (trial number 2006-000995-33), and is closed to recruitment. FINDINGS Between Jan 31, 2007, and Jan 30, 2013, 2102 patients were recruited. 737 (35%) of the 2102 recruited patients were in treatment group 1 (early-stage disease) and were not included in our analysis. 1365 (65%) of the 2102 patients were in treatment group 2 (intermediate-stage disease; n=455) and treatment group 3 (advanced-stage disease; n=910). Of these 1365, 1287 (94%) patients (435 [34%] of 1287 in treatment group 2 and 852 [66%] of 1287 in treatment group 3) were included in the titration trial per-protocol analysis. 937 (69%) of 1365 patients were randomly assigned to COPP (n=471) or COPDAC (n=466) in the embedded trial. Median follow-up was 66·5 months (IQR 62·7-71·7). Of 1287 patients in the per-protocol group, 514 (40%) had an adequate response to treatment and were not treated with radiotherapy (215 [49%] of 435 in treatment group 2 and 299 [35%] of 852 in treatment group 3). 773 (60%) of 1287 patients with inadequate response were scheduled for radiotherapy (220 [51%] of 435 in the treatment group 2 and 553 [65%] of 852 in treatment group 3. In patients who responded adequately, event-free survival rates at 5 years were 90·1% (95% CI 87·5-92·7). event-free survival rates at 5 years in 892 patients who were randomly assigned to treatment and analysed per protocol were 89·9% (95% CI 87·1-92·8) for COPP (n=444) versus 86·1% (82·9-89·4) for COPDAC (n=448). The COPDAC minus COPP difference in event-free survival at 5 years was -3·7% (-8·0 to 0·6). The most common grade 3-4 adverse events (intention-to-treat population) were decreased haemoglobin (205 [15%] of 1365 patients during OEPA vs 37 [7%] of 528 treated with COPP vs 20 [2%] of 819 treated with COPDAC), decreased white blood cells (815 [60%] vs 231 [44%] vs 84 [10%]), and decreased neutrophils (1160 [85%] vs 223 [42%] vs 174 [21%]). One patient in treatment group 2 died of sepsis after the first cycle of OEPA; no other treatment-related deaths occurred. INTERPRETATION Our results show that radiotherapy can be omitted in patients who adequately respond to treatment, when consolidated with COPP or COPDAC. COPDAC might be less effective, but is substantially less gonadotoxic than COPP. A high proportion of patients could therefore be spared radiotherapy, eventually reducing the late effects of treatment. With more refined criteria for response assessment, the number of patients who receive radiotherapy will be further decreased. FUNDING Deutsche Krebshilfe, Elternverein für Krebs-und leukämiekranke Kinder Gießen, Kinderkrebsstiftung Mainz, Tour der Hoffnung, Menschen für Kinder, Programme Hospitalier de Recherche Clinique, and Cancer Research UK.
Collapse
Affiliation(s)
- Christine Mauz-Körholz
- Department of Paediatric Oncology, Justus-Liebig- University Giessen, Giessen, Germany; Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Judith Landman-Parker
- Department of Paediatric Haematology-Oncology, Sorbonne Université and APHP-SIRIC CURAMUS Hôpital a Trousseau, Paris, France
| | - Walentyna Balwierz
- Department of Paediatric Oncology and Haematology, Institute of Paediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Roland A Ammann
- Paediatric Haematology and Oncology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern Switzerland
| | - Richard A Anderson
- MRC Centre for Reproductive Health, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Andische Attarbaschi
- Department of Paediatric Haematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Jörg M Bartelt
- Department of Radiology, University Hospital Halle, Halle, Germany
| | - Auke Beishuizen
- Princess Máxima Centre for Paediatric Oncology, Utrecht and Erasmus, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Sabah Boudjemaa
- Department of Pathology, Armand Trousseau Hospital, Paris, France
| | - Michaela Cepelova
- Department of Paediatric Haematology and Oncology, University Hospital Motol, Prague, Czech Republic
| | - Alexander Claviez
- Department of Paediatrics, University of Schleswig-Holstein, Kiel, Germany
| | - Stephen Daw
- Children and Young People's Cancer Service, University College Hospital London, London, UK
| | - Karin Dieckmann
- Strahlentherapie AKH Wien Medizinische, Universitätsklinik Wien, Vienna, Austria
| | | | | | | | - Thomas Georgi
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Lisa L Hjalgrim
- Department of Paediatrics and Adolescent Medicine, The Juliane Marie Centre, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Andrea Hraskova
- Department of Paediatric Haematology and Oncology, National Institute of Children's Disease and Comenius University, Bratislava, Slovakia
| | - Jonas Karlén
- Department of Paediatric Oncology at Astrid Lindgrens Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Regine Kluge
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Lars Kurch
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Thiery Leblanc
- Service d'Hématologie Pédiatrique, Hôpital Robert-Debré, Paris, France
| | - Georg Mann
- St Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Francoise Montravers
- Department of Nuclear Medicine, Tenon Hospital, APHP and Sorbonne Université, Paris, France
| | - Jean Pears
- Our Lady's Hospital for Children's Health, Dublin, Ireland
| | - Tanja Pelz
- Department of Radiation Oncology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Vladan Rajić
- Clinical Department of Paediatric Haematology, Oncology, and Stem Cell Transplantation, University Medical Centre Ljubljana and University Children's Hospital, Ljubljana, Slovenia
| | - Alan D Ramsay
- Department of Cellular Pathology, University College Hospital London, London, UK
| | | | - Anne Uyttebroeck
- Paediatric Haematology and Oncology, Department of Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Dirk Vordermark
- Department of Radiation Oncology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Dieter Körholz
- Department of Paediatric Oncology, Justus-Liebig- University Giessen, Giessen, Germany
| | - Dirk Hasenclever
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - William Hamish Wallace
- Department of Paediatric Haematology and Oncology, Royal Hospital for Children and Young People and University of Edinburgh, Edinburgh, UK.
| |
Collapse
|
8
|
Byrjalsen A, Hansen TVO, Stoltze UK, Mehrjouy MM, Barnkob NM, Hjalgrim LL, Mathiasen R, Lautrup CK, Gregersen PA, Hasle H, Wehner PS, Tuckuviene R, Sackett PW, Laspiur AO, Rossing M, Marvig RL, Tommerup N, Olsen TE, Scheie D, Gupta R, Gerdes A, Schmiegelow K, Wadt K. Nationwide germline whole genome sequencing of 198 consecutive pediatric cancer patients reveals a high incidence of cancer prone syndromes. PLoS Genet 2020; 16:e1009231. [PMID: 33332384 PMCID: PMC7787686 DOI: 10.1371/journal.pgen.1009231] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 01/06/2021] [Accepted: 10/28/2020] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Historically, cancer predisposition syndromes (CPSs) were rarely established for children with cancer. This nationwide, population-based study investigated how frequently children with cancer had or were likely to have a CPS. METHODS Children (0-17 years) in Denmark with newly diagnosed cancer were invited to participate in whole-genome sequencing of germline DNA. Suspicion of CPS was assessed according to Jongmans'/McGill Interactive Pediatric OncoGenetic Guidelines (MIPOGG) criteria and familial cancer diagnoses were verified using population-based registries. RESULTS 198 of 235 (84.3%) eligible patients participated, of whom 94/198 (47.5%) carried pathogenic variants (PVs) in a CPS gene or had clinical features indicating CPS. Twenty-nine of 198 (14.6%) patients harbored a CPS, of whom 21/198 (10.6%) harbored a childhood-onset and 9/198 (4.5%) an adult-onset CPS. In addition, 23/198 (11.6%) patients carried a PV associated with biallelic CPS. Seven of the 54 (12.9%) patients carried two or more variants in different CPS genes. Seventy of 198 (35.4%) patients fulfilled the Jongmans' and/or MIPOGG criteria indicating an underlying CPS, including two of the 9 (22.2%) patients with an adult-onset CPS versus 18 of the 21 (85.7%) patients with a childhood-onset CPS (p = 0.0022), eight of the additional 23 (34.8%) patients with a heterozygous PV associated with biallelic CPS, and 42 patients without PVs. Children with a central nervous system (CNS) tumor had family members with CNS tumors more frequently than patients with other cancers (11/44, p = 0.04), but 42 of 44 (95.5%) cases did not have a PV in a CPS gene. CONCLUSION These results demonstrate the value of systematically screening pediatric cancer patients for CPSs and indicate that a higher proportion of childhood cancers may be linked to predisposing germline variants than previously supposed.
Collapse
Affiliation(s)
- Anna Byrjalsen
- Department of Clinical Genetics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Thomas V. O. Hansen
- Department of Clinical Genetics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Ulrik K. Stoltze
- Department of Clinical Genetics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Mana M. Mehrjouy
- Department of Clinical Genetics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Nanna Moeller Barnkob
- Department of Health Technology, Technical University of Denmark, Copenhagen, Denmark
| | - Lisa L. Hjalgrim
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - René Mathiasen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | | | - Henrik Hasle
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Peder S. Wehner
- Department of Paediatric Hematology and Oncology, H. C. Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
| | - Ruta Tuckuviene
- Department of Paediatrics and Adolescent Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Wad Sackett
- Department of Health Technology, Technical University of Denmark, Copenhagen, Denmark
| | - Adrian O. Laspiur
- Department of Health Technology, Technical University of Denmark, Copenhagen, Denmark
| | - Maria Rossing
- Center for Genomic Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Rasmus L. Marvig
- Center for Genomic Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Niels Tommerup
- Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Tina Elisabeth Olsen
- Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - David Scheie
- Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Ramneek Gupta
- Department of Health Technology, Technical University of Denmark, Copenhagen, Denmark
| | - Anne–Marie Gerdes
- Department of Clinical Genetics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Karin Wadt
- Department of Clinical Genetics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- * E-mail:
| |
Collapse
|
9
|
Østrup O, Nysom K, Scheie D, Schmidt AY, Mathiasen R, Hjalgrim LL, Olsen TE, Skjøth-Rasmussen J, Henriksen BM, Nielsen FC, Wehner PS, Schrøder H, Sehested AM, Rechnitzer C, Rossing M. Importance of Comprehensive Molecular Profiling for Clinical Outcome in Children With Recurrent Cancer. Front Pediatr 2018; 6:114. [PMID: 29732366 PMCID: PMC5920151 DOI: 10.3389/fped.2018.00114] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 04/05/2018] [Indexed: 11/29/2022] Open
Abstract
Purpose: Pediatric cancers are often difficult to classify and can be complex to treat. To ensure precise diagnostics and identify relevant treatment targets, we implemented comprehensive molecular profiling of consecutive pediatric patients with cancer relapse. We evaluated the clinical impact of extensive molecular profiling by assessing the frequency of identified biological onco-drivers, altered diagnosis, and/or identification of new relevant targeted therapies. Patients and Methods: Forty-six tumor samples (44 fresh-frozen; two formalin-fixed paraffin embedded), two bone marrow aspirates, three cerebrospinal fluid samples, and one archived DNA were obtained from 48 children (0-17 years; median 9.5) with relapsed or refractory cancer, where the disease was rapidly progressing in spite of their current treatment or they had exhausted all treatment options. The samples were analyzed by whole-exome sequencing (WES), RNA sequencing (RNAseq), transcriptome arrays, and SNP arrays. Final reports were available within 3-4 weeks after patient inclusion and included mutation status, a description of copy number alterations, differentially expressed genes, and gene fusions, as well as suggestions for targeted treatment. Results: Of the 48 patients, 33 had actionable findings. The most efficient method for the identification of actionable findings was WES (39%), followed by SNP array (37%). Of note, gene fusions were identified by RNAseq in 21% of the samples. Eleven findings led to clinical intervention, i.e., oncogenetic counseling, targeted treatment, and treatment based on changed diagnosis. Four patients received compassionate use targeted therapy. Six patients experienced direct benefits in the form of stable disease or response. Conclusion: The application of comprehensive genetic diagnostics in children with recurrent cancers allowed for discovery and implementation of effective targeted therapies and hereby improvement of outcome in some patients.
Collapse
Affiliation(s)
- Olga Østrup
- Center for Genomic Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Karsten Nysom
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - David Scheie
- Department of Pathology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ane Y Schmidt
- Center for Genomic Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Rene Mathiasen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lisa L Hjalgrim
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Tina E Olsen
- Department of Pathology, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Birthe M Henriksen
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Finn C Nielsen
- Center for Genomic Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peder S Wehner
- HCA Hospital for Children, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Henrik Schrøder
- Department of Clinical Medicine - Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Astrid M Sehested
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Catherine Rechnitzer
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maria Rossing
- Center for Genomic Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| |
Collapse
|
10
|
Nielsen SN, Eriksson F, Rosthoej S, Andersen MK, Forestier E, Hasle H, Hjalgrim LL, Aasberg A, Abrahamsson J, Heyman M, Jónsson ÓG, Pruunsild K, Vaitkeviciené GE, Vettenranta K, Schmiegelow K. Children with low-risk acute lymphoblastic leukemia are at highest risk of second cancers. Pediatr Blood Cancer 2017; 64. [PMID: 28500740 DOI: 10.1002/pbc.26518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 02/02/2017] [Accepted: 02/09/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND The improved survival rates for childhood acute lymphoblastic leukemia (ALL) may be jeopardized by the development of a second cancer, which has been associated with thiopurine therapy. PROCEDURE We retrospectively analyzed three sequential Nordic Society of Paediatric Haematology and Oncology's protocols characterized by increasing intensity of thiopurine-based maintenance therapy. We explored the risk of second cancer in relation to protocols, risk group, thiopurine methyltransferase (TPMT) activity, ALL high hyperdiploidy (HeH), and t(12;21)[ETV6/RUNX1]. RESULTS After median 9.5 years (interquartile range, 5.4-15.3 yrs) of follow-up, 40 of 3,591 patients had developed a second cancer, of whom 38 had non-high-risk B-cell precursor ALL. Patients with standard-risk ALL, who received the longest maintenance therapy, had the highest adjusted hazard of second cancer (hazard ratio [HR], intermediate vs. standard risk: 0.16, 95% CI: 0.06-0.43, P < 0.001; HR, high vs. standard risk: 0.09, 95% CI: 0.02-0.49, P = 0.006); no significant effects of protocol, age, or white blood cell count at diagnosis, ALL HeH, or t(12;21)[ETV6/RUNX1] were observed. A subset analysis on the patients with standard-risk ALL did not show an increased hazard of second cancer from either HeH or t(12;21) (adjusted HR 2.02, 95% CI: 0.69-5.96, P = 0.20). The effect of low TPMT low activity was explored in patients reaching maintenance therapy in clinical remission (n = 3,368); no association with second cancer was observed (adjusted HR 1.43, 95% CI: 0.54-3.76, P = 0.47). CONCLUSIONS The rate of second cancer was generally highest in patients with low-risk ALL, but we could not identify a subset at higher risk than others.
Collapse
Affiliation(s)
- Stine N Nielsen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Frank Eriksson
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Rosthoej
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mette K Andersen
- Department of Clinical Genetics, Copenhagen University Hospital, Copenhagen, Denmark
| | - Erik Forestier
- Department of Medical Biosciences, Clinical Genetics, Umeå University, Umeå, Sweden
| | - Henrik Hasle
- Department of Paediatrics, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Lisa L Hjalgrim
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ann Aasberg
- Department of Paediatrics, University Hospital of Trondheim, Trondheim, Norway
| | - Jonas Abrahamsson
- Department of Pediatrics, Institution for Clinical Sciences Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mats Heyman
- Department of Paediatric Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Ólafur G Jónsson
- Pediatric Hematology-Oncology, Children's Hospital, Barnaspitali Hringsins, Landspitali University Hospital, Reykjavik, Iceland
| | - Kaie Pruunsild
- Department of Oncology and Hematology, Tallinn Children's Hospital, Tallinn, Estonia
| | - Goda E Vaitkeviciené
- Centre for Paediatric Oncology and Haematology, University Children's Hospital, Vilnius, Lithuania
| | - Kim Vettenranta
- Department of Paediatrics, University of Tampere, Tampere, Finland
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
11
|
Hjalgrim LL, Madsen HO, Melbye M, Jørgensen P, Christiansen M, Andersen MT, Pallisgaard N, Hokland P, Clausen N, Ryder LP, Schmiegelow K, Hjalgrim H. Presence of clone-specific markers at birth in children with acute lymphoblastic leukaemia. Br J Cancer 2002; 87:994-9. [PMID: 12434291 PMCID: PMC2364323 DOI: 10.1038/sj.bjc.6600601] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2002] [Revised: 07/12/2002] [Accepted: 08/05/2002] [Indexed: 11/26/2022] Open
Abstract
Recent studies have suggested that development of childhood acute lymphoblastic leukaemia may often be initiated in utero. To provide further evidence of an prenatal origin of childhood leukaemia, we conducted a molecular biological investigation of nine children with B-precursor acute lymphoblastic leukaemia carrying the chromosomal translocation t(12;21), the most common subtype of all childhood acute lymphoblastic leukaemia. Specifically, for each child we identified the non-constitutive chromosomal sequences made up by the t(12;21) fusion gene. From these, leukaemia clone-specific DNA primers were constructed and applied in nested polymerase chain reaction analyses of DNA extracted from the patients' Guthrie cards obtained at birth. Leukaemia clone-specific fusion gene regions were demonstrated in Guthrie card DNA of three patients, age 2 years 11 months, 3 years 4 months, and 5 years 8 months at leukaemia diagnosis. Our findings are consistent with previous observations, and thus provide further evidence that the development of t(12;21) B-precursor acute lymphoblastic leukaemia may be initiated in utero. Review of the current literature moreover indicates that age at leukaemia may be inversely correlated with the burden of cells with leukaemia clonal markers, i.e. leukaemia predisposed cells at birth, and that certain types of childhood acute lymphoblastic leukaemia develop as a multiple step process involving both pre- and postnatal genetic events.
Collapse
MESH Headings
- Adolescent
- Base Sequence
- Biomarkers, Tumor/genetics
- Blood Specimen Collection
- Child
- Child, Preschool
- Chromosomes, Human, Pair 12/genetics
- Chromosomes, Human, Pair 21/genetics
- Core Binding Factor Alpha 2 Subunit
- DNA Primers/chemistry
- DNA, Neoplasm/analysis
- Female
- Gene Rearrangement
- Genes, Immunoglobulin
- Genetic Predisposition to Disease
- Humans
- Infant
- Infant, Newborn
- Male
- Mannose-Binding Lectin/genetics
- Mannose-Binding Lectin/metabolism
- Molecular Sequence Data
- Neoplasm Proteins/genetics
- Oncogene Proteins, Fusion/genetics
- Polymerase Chain Reaction
- Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/genetics
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/genetics
- Translocation, Genetic/genetics
Collapse
Affiliation(s)
- L L Hjalgrim
- Department of Epidemiology Research, Danish Epidemiology Science Centre, Statens Serum Institut, Artillerivej 5, DK- 2300 Copenhagen S, Denmark
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Andersen MT, Nordentoft I, Hjalgrim LL, Christiansen CL, Jakobsen VD, Hjalgrim H, Pallisgaard N, Madsen HO, Christiansen M, Ryder LP, Clausen N, Hokland P, Schmiegelow K, Melbye M, Jørgensen P. Characterization of t(12;21) breakpoint junctions in acute lymphoblastic leukemia. Leukemia 2001; 15:858-9. [PMID: 11368451 DOI: 10.1038/sj.leu.2402095] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2000] [Accepted: 01/19/2001] [Indexed: 11/09/2022]
|
13
|
Lei U, Wohlfahrt J, Hjalgrim H, Hjalgrim LL, Simonsen H, Melbye M. Neonatal level of thyroid-stimulating hormone and acute childhood leukemia. Int J Cancer 2000; 88:486-8. [PMID: 11054681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
One of the more consistent findings in leukemia research is the association between birth weight and childhood leukemia. Because thyroid hormones are critically involved in growth and differentiation, we speculated that hormone levels could be of significance to the development of leukemia in early life. Specifically, we hypothesized that high levels of thyroid-stimulating hormone (TSH) would be associated with a low risk of leukemia. Accordingly, high TSH (low free thyroid hormone) early after birth most likely reflects low function of the thyroid accompanied by low rate of cell turnover and so lower risk of faulty cell divisions leading to cancer. In a matched case-control study nested from all singleton children born in Denmark between 1986 and 1998, we compared levels of TSH (as measured in a neonatal screening program for congenital hypothyroidism) in 188 cases of acute lymphoblastic leukemia (ALL) and 28 of acute myeloid leukemia (AML) with levels in 1,450 and 216 matched controls, respectively. Data were analyzed using conditional logistic regression and odds ratios (OR) were adjusted for birth weight. As hypothesized, we found a decreased risk of ALL and AML associated with high TSH (OR(ALL) = 0.7 [0.5-1.0]; OR(AML) = 0.3 [0.1-1.0]). However, both conditions were also associated with low levels of TSH (OR(ALL) = 0.4 [0.2-0.7]; OR(AML) = 0.3 [0.1-1.4]). In conclusion, extreme TSH levels a few days after birth appears to be associated with a decreased risk of acute childhood leukemia.
Collapse
Affiliation(s)
- U Lei
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | | | | | | | | | | |
Collapse
|