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Zahid N, Enam SA, Mårtensson T, Azam I, Mushtaq N, Moochhala M, Javed F, Kausar F, Hasan A, Rehman L, Mughal MN, Altaf S, Kirmani S, Brown N. Predictors of neurocognition outcomes in children and young people with primary brain tumor presenting to tertiary care hospitals of Karachi, Pakistan: a prospective cohort study. Childs Nerv Syst 2024; 40:1707-1719. [PMID: 38363314 DOI: 10.1007/s00381-024-06306-x] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/28/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Primary brain tumors are a common cause of morbidity and mortality in children and young people (CYP) globally. Impaired neurocognitive function is a potential severe consequence in primary brain tumor (PBT) survivors. There are no in-depth studies from low- and middle-income countries (LMICs) to inform management and follow-up. The research questions of this study were as follows: Are the sociodemographic factors (lower age of CYP, female gender, low socioeconomic status, low parental education), disease-related factors (high grade of tumor, presence of seizures, presence of hydrocephalous), and treatment-related factors (adjuvant therapy, no surgical intervention, post-treatment seizures, placement of shunts) associated with decline in neurcognition outcomes 12 months post-treatment in CYP with PBTs? METHODS A prospective cohort study was conducted from November 2020 to July 2023 at the Aga Khan University Hospital and Jinnah Postgraduate Medical Centre, tertiary care hospitals in Karachi, Pakistan. All CYP aged 5 to 21 years with a newly diagnosed PBTs were eligible. The neurocognition assessment was undertaken by a psychologist at two points, i.e., pre-treatment and at 12 months post-treatment using validated tools. The verbal intelligence was assessed by Slosson Intelligence tool, revised 3rd edition (SIT-R3), perceptual reasoning by Raven's Progressive Matrices (RPM), and the Processing Speed Index by Wechsler Intelligence Scale (WISC V) and Wechsler Adult Intelligence Scale (WAIS-IV). The data were analyzed by STATA version 12 software. Generalized estimating equation (GEE) was used to determine the factors associated with the mean change in 12 months post-treatment verbal and non-verbal neurocognition scores. Unadjusted and adjusted beta coefficients with their 95% confidence intervals were reported. RESULTS A total of 48 CYPs with PBTs were enrolled, 23 (48%) of them were lost to follow-up and 10 (21%) died. The remaining 25 (52%) were reassessed 12 months after treatment. On multivariable analysis, a significant decline in verbal intelligence scores at 12 months was predicted by post-treatment seizures beta = - 20.8 (95% CI, - 38.2, - 3.4), mothers having no formal educational status and lower household monthly income. Similarly, a significant decline in perceptual reasoning scores was also predicted by post-treatment seizures beta = - 10.7 (95% CI, - 20.6, - 0.8), mothers having no formal education and having lower household monthly income. Worsening of processing speed scores at 12 months post-treatment were predicted by tumor histology, post-treatment seizures beta = - 33.9 (95% CI, - 47.7, - 20.0), lower educational status of the mother, and having lower household monthly. However, an improvement was seen in processing speed scores after surgical tumor resection. CONCLUSION In this novel study, the post-treatment mean change in verbal and non-verbal neurocognition scores was associated with sociodemographic, tumor, and treatment factors. These findings may have potential implications for targeted early psychological screening of higher risk CYP with PBTs. Identification of these predictors may serve as a foundation for developing more cost-effective treatment thereby alleviating the burden of neurocognitive morbidity. However to establish generalizability, future research should prioritize larger-scale, multicountry studies. (Trial registration: ClinicalTrials.gov Identifier: NCT05709522).
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Affiliation(s)
- Nida Zahid
- Department of Surgery, Aga Khan University, Karachi, Pakistan.
- Global Health and Migration Unit, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - S Ather Enam
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Thomas Mårtensson
- Global Health and Migration Unit, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Iqbal Azam
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Naureen Mushtaq
- Department of Pediatric Oncology, Aga Khan University, Karachi, Pakistan
| | - Mariya Moochhala
- Department of Psychiatry, Aga Khan University, Karachi, Pakistan
| | - Farrukh Javed
- Department of Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Faiza Kausar
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Aneesa Hasan
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Lal Rehman
- Department of Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - M Nouman Mughal
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Sadaf Altaf
- Department of Pediatric Oncology, Aga Khan University, Karachi, Pakistan
| | - Salman Kirmani
- Division of Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Nick Brown
- Global Health and Migration Unit, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
- Department of Pediatrics, Aga Khan University, Karachi, Pakistan.
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Zahid S, Bashir F, Minhas K, Hilal K, Mushtaq N. Case of embryonal tumor multilayered rosettes in a patient with neurofibromatosis type 1. Childs Nerv Syst 2024:10.1007/s00381-024-06442-4. [PMID: 38713208 DOI: 10.1007/s00381-024-06442-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 04/27/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND ETMR is a unique and highly malignant brain tumor mostly occurring in infants. This report provides a comprehensive overview of the clinical presentation, histological aspects, radiological features, and therapeutic options of ETMR. Being the first report on the co-occurrence of NF1 with ETMR, it highlight the challenges of managing a patient with complex medical conditions. CASE REPORT We present a case of a 3 and 1/2-year-old girl with neurofibromatosis type 1 (NF1), later diagnosed with a supratentorial brain tumor reported as an embryonal tumor with multilayered rosettes (ETMR), along with possible co-occurrence of constitutional mismatch repair deficiency (CMMRD) on immunohistochemistry (IHC); however, germline testing was not performed. Even though NF1 can be associated with tumors such as gliomas, the literature has no previous case reports of ETMR coexisting with NF1. CONCLUSION Exploring the link between NF1 and ETMR with CMMRD is crucial to improving and establishing more treatment protocols. Therefore, reporting each case's unique features would be essential in developing appropriate treatment protocols.
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Affiliation(s)
- Soha Zahid
- Section of Pediatric-Oncology, Department of Oncology, Aga Khan University Hospital Karachi, Stadium Road, Karsaz, Karachi, Pakistan
| | - Farrah Bashir
- Section of Pediatric-Oncology, Department of Oncology, Aga Khan University Hospital Karachi, Stadium Road, Karsaz, Karachi, Pakistan.
| | - Khurram Minhas
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital Karachi, Karachi, Pakistan
| | - Kiran Hilal
- Department of Radiology, Aga Khan University, Karachi, Pakistan
| | - Naureen Mushtaq
- Section of Pediatric-Oncology, Department of Oncology, Aga Khan University Hospital Karachi, Stadium Road, Karsaz, Karachi, Pakistan
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Gilani A, Mushtaq N, Shakir M, Altaf A, Siddiq Z, Bouffet E, Tabori U, Hawkins C, Minhas K. Pediatric neuropathology practice in a low- and middle-income country: capacity building through institutional twinning. Front Oncol 2024; 14:1328374. [PMID: 38764578 PMCID: PMC11102046 DOI: 10.3389/fonc.2024.1328374] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 04/10/2024] [Indexed: 05/21/2024] Open
Abstract
Background Accurate and precise diagnosis is central to treating central nervous system (CNS) tumors, yet tissue diagnosis is often a neglected focus in low- and middle-income countries (LMICs). Since 2016, the WHO classification of CNS tumors has increasingly incorporated molecular biomarkers into the diagnosis of CNS tumors. While this shift to precision diagnostics promises a high degree of diagnostic accuracy and prognostic precision, it has also resulted in increasing divergence in diagnostic and management practices between LMICs and high-income countries (HICs). Pathologists and laboratory professionals in LMICs lack the proper training and tools to join the molecular diagnostic revolution. We describe the impact of a 7-year long twinning program between Canada and Pakistan on pathology services. Methods During the study period, 141 challenging cases of pediatric CNS tumors initially diagnosed at Aga Khan University Hospital (AKUH), Karachi, were sent to the Hospital for Sick Children in Toronto, Canada (SickKids), for a second opinion. Each case received histologic review and often immunohistochemical staining and relevant molecular testing. A monthly multidisciplinary online tumor board (MDTB) was conducted to discuss the results with pathologists from both institutions in attendance. Results Diagnostic discordance was seen in 30 cases. Expert review provided subclassification for 53 cases most notably for diffuse gliomas and medulloblastoma. Poorly differentiated tumors benefited the most from second review, mainly because of the resolving power of specialized immunohistochemical stains, NanoString, and targeted gene panel next-generation sequencing. Collaboration with expert neuropathologists led to validation of over half a dozen immunostains at AKUH facilitating diagnosis of CNS tumors. Conclusions LMIC-HIC Institutional twinning provides much-needed training and mentorship to pathologists and can help in infrastructure development by adopting and validating new immunohistochemical stains. Persistent unresolved cases indicate that molecular techniques are indispensable in for diagnosis in a minority of cases. The development of affordable alternative molecular techniques may help with these histologically unresolved cases.
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Affiliation(s)
- Ahmed Gilani
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Medicine, The Aga Khan University, Karachi, Pakistan
| | - Naureen Mushtaq
- Department of Oncology, The Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Shakir
- Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
| | - Ahmed Altaf
- Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
| | - Zainab Siddiq
- Department of Medicine, The Aga Khan University, Karachi, Pakistan
| | - Eric Bouffet
- Neurooncology Program, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
- Global Pediatric Medicine Department, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Uri Tabori
- Neurooncology Program, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Cynthia Hawkins
- Department of Pathology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Khurram Minhas
- Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, Pakistan
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4
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Ercan AB, Aronson M, Fernandez NR, Chang Y, Levine A, Liu ZA, Negm L, Edwards M, Bianchi V, Stengs L, Chung J, Al-Battashi A, Reschke A, Lion A, Ahmad A, Lassaletta A, Reddy AT, Al-Darraji AF, Shah AC, Van Damme A, Bendel A, Rashid A, Margol AS, Kelly BL, Pencheva B, Heald B, Lemieux-Anglin B, Crooks B, Koschmann C, Gilpin C, Porter CC, Gass D, Samuel D, Ziegler DS, Blumenthal DT, Kuo DJ, Hamideh D, Basel D, Khuong-Quang DA, Stearns D, Opocher E, Carceller F, Baris Feldman H, Toledano H, Winer I, Scheers I, Fedorakova I, Su JM, Vengoechea J, Sterba J, Knipstein J, Hansford JR, Gonzales-Santos JR, Bhatia K, Bielamowicz KJ, Minhas K, Nichols KE, Cole KA, Penney L, Hjort MA, Sabel M, Gil-da-Costa MJ, Murray MJ, Miller M, Blundell ML, Massimino M, Al-Hussaini M, Al-Jadiry MF, Comito MA, Osborn M, Link MP, Zapotocky M, Ghalibafian M, Shaheen N, Mushtaq N, Waespe N, Hijiya N, Fuentes-Bolanos N, Ahmad O, Chamdine O, Roy P, Pichurin PN, Nyman P, Pearlman R, Auer RC, Sukumaran RK, Kebudi R, Dvir R, Raphael R, Elhasid R, McGee RB, Chami R, Noss R, Tanaka R, Raskin S, Sen S, Lindhorst S, Perreault S, Caspi S, Riaz S, Constantini S, Albert S, Chaleff S, Bielack S, Chiaravalli S, Cramer SL, Roy S, Cahn S, Penna S, Hamid SA, Ghafoor T, Imam U, Larouche V, Magimairajan Issai V, Foulkes WD, Lee YY, Nathan PC, Maruvka YE, Greer MLC, Durno C, Shlien A, Ertl-Wagner B, Villani A, Malkin D, Hawkins C, Bouffet E, Das A, Tabori U. Clinical and biological landscape of constitutional mismatch-repair deficiency syndrome: an International Replication Repair Deficiency Consortium cohort study. Lancet Oncol 2024; 25:668-682. [PMID: 38552658 DOI: 10.1016/s1470-2045(24)00026-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/29/2023] [Accepted: 01/14/2024] [Indexed: 05/04/2024]
Abstract
BACKGROUND Constitutional mismatch repair deficiency (CMMRD) syndrome is a rare and aggressive cancer predisposition syndrome. Because a scarcity of data on this condition contributes to management challenges and poor outcomes, we aimed to describe the clinical spectrum, cancer biology, and impact of genetics on patient survival in CMMRD. METHODS In this cohort study, we collected cross-sectional and longitudinal data on all patients with CMMRD, with no age limits, registered with the International Replication Repair Deficiency Consortium (IRRDC) across more than 50 countries. Clinical data were extracted from the IRRDC database, medical records, and physician-completed case record forms. The primary objective was to describe the clinical features, cancer spectrum, and biology of the condition. Secondary objectives included estimations of cancer incidence and of the impact of the specific mismatch-repair gene and genotype on cancer onset and survival, including after cancer surveillance and immunotherapy interventions. FINDINGS We analysed data from 201 patients (103 males, 98 females) enrolled between June 5, 2007 and Sept 9, 2022. Median age at diagnosis of CMMRD or a related cancer was 8·9 years (IQR 5·9-12·6), and median follow-up from diagnosis was 7·2 years (3·6-14·8). Endogamy among minorities and closed communities contributed to high homozygosity within countries with low consanguinity. Frequent dermatological manifestations (117 [93%] of 126 patients with complete data) led to a clinical overlap with neurofibromatosis type 1 (35 [28%] of 126). 339 cancers were reported in 194 (97%) of 201 patients. The cumulative cancer incidence by age 18 years was 90% (95% CI 80-99). Median time between cancer diagnoses for patients with more than one cancer was 1·9 years (IQR 0·8-3·9). Neoplasms developed in 15 organs and included early-onset adult cancers. CNS tumours were the most frequent (173 [51%] cancers), followed by gastrointestinal (75 [22%]), haematological (61 [18%]), and other cancer types (30 [9%]). Patients with CNS tumours had the poorest overall survival rates (39% [95% CI 30-52] at 10 years from diagnosis; log-rank p<0·0001 across four cancer types), followed by those with haematological cancers (67% [55-82]), gastrointestinal cancers (89% [81-97]), and other solid tumours (96% [88-100]). All cancers showed high mutation and microsatellite indel burdens, and pathognomonic mutational signatures. MLH1 or MSH2 variants caused earlier cancer onset than PMS2 or MSH6 variants, and inferior survival (overall survival at age 15 years 63% [95% CI 55-73] for PMS2, 49% [35-68] for MSH6, 19% [6-66] for MLH1, and 0% for MSH2; p<0·0001). Frameshift or truncating variants within the same gene caused earlier cancers and inferior outcomes compared with missense variants (p<0·0001). The greater deleterious effects of MLH1 and MSH2 variants as compared with PMS2 and MSH6 variants persisted despite overall improvements in survival after surveillance or immune checkpoint inhibitor interventions. INTERPRETATION The very high cancer burden and unique genomic landscape of CMMRD highlight the benefit of comprehensive assays in timely diagnosis and precision approaches toward surveillance and immunotherapy. These data will guide the clinical management of children and patients who survive into adulthood with CMMRD. FUNDING The Canadian Institutes for Health Research, Stand Up to Cancer, Children's Oncology Group National Cancer Institute Community Oncology Research Program, Canadian Cancer Society, Brain Canada, The V Foundation for Cancer Research, BioCanRx, Harry and Agnieszka Hall, Meagan's Walk, BRAINchild Canada, The LivWise Foundation, St Baldrick Foundation, Hold'em for Life, and Garron Family Cancer Center.
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Affiliation(s)
- Ayse Bahar Ercan
- Arthur and Sonia Labatt Brain Tumor Research Centre, Toronto, ON, Canada
| | - Melyssa Aronson
- Zane Cohen Centre for Digestive Diseases, Sinai Health System, Toronto, ON, Canada
| | | | - Yuan Chang
- Arthur and Sonia Labatt Brain Tumor Research Centre, Toronto, ON, Canada
| | - Adrian Levine
- Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Zhihui Amy Liu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Logine Negm
- Arthur and Sonia Labatt Brain Tumor Research Centre, Toronto, ON, Canada
| | - Melissa Edwards
- Arthur and Sonia Labatt Brain Tumor Research Centre, Toronto, ON, Canada
| | - Vanessa Bianchi
- Arthur and Sonia Labatt Brain Tumor Research Centre, Toronto, ON, Canada
| | - Lucie Stengs
- Arthur and Sonia Labatt Brain Tumor Research Centre, Toronto, ON, Canada
| | - Jiil Chung
- Arthur and Sonia Labatt Brain Tumor Research Centre, Toronto, ON, Canada
| | - Abeer Al-Battashi
- Department of Pediatric Hematology and Oncology, The Royal Hospital, Muscat, Oman
| | - Agnes Reschke
- Division of Pediatric Hematology/Oncology, Stanford Medicine, Stanford, CA, USA
| | - Alex Lion
- Department of Pediatric Hematology/Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Alia Ahmad
- University of Child Health Sciences, Children's Hospital Lahore, Lahore, Pakistan
| | - Alvaro Lassaletta
- Department of Pediatric Hematology-Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain
| | | | - Amir F Al-Darraji
- College of Medicine, University of Baghdad, Paediatric Oncology Unit, Baghdad, Iraq
| | - Amish C Shah
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - An Van Damme
- Division of Pediatric Hematology and Oncology, Institut Roi Albert II, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | - Aqeela Rashid
- Department of Pediatric Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Ashley S Margol
- Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine University of Southern California, Los Angeles, CA, USA
| | | | - Bojana Pencheva
- Alfac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Brandie Heald
- Department of Gastroenterology, Hepatology, and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Brianna Lemieux-Anglin
- Departments of Oncology and Human Genetics, McGill University Health Centre, Cancer Genetics Program, Montreal, QC, Canada
| | - Bruce Crooks
- Division of Hematology-Oncology, IWK Health, Halifax, NS, Canada
| | - Carl Koschmann
- Department of Pediatric Hematology-Oncology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Catherine Gilpin
- Children's Hospital of Eastern Ontario, Genetics, Ottawa, ON, Canada
| | - Christopher C Porter
- Alfac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - David Gass
- Department of Pediatric Hematology and Oncology, Atrium Health, Charlotte, NC, USA
| | | | - David S Ziegler
- Kid's Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia
| | - Deborah T Blumenthal
- Neuro-Oncology Division, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Dennis John Kuo
- Division of Pediatric Hematology/Oncology, University of California, San Diego, CA, USA
| | - Dima Hamideh
- Division of Pediatric Hematology-Oncology, American University of Beirut, Beirut, Lebanon
| | - Donald Basel
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Duncan Stearns
- UH Rainbow Babies and Children's Hospital Division of Pediatrics, Pediatric Neuro-oncology, Cleveland, OH, USA
| | - Enrico Opocher
- Pediatric Hematology, Oncology and Stem Cell Transplant Division, Padua University Hospital, Padua, Italy
| | - Fernando Carceller
- Children and Young People's Unit, Royal Marsden NHS Foundation Trust, London, UK; Division of Clinical Studies, The Institute of Cancer Research, London, UK
| | - Hagit Baris Feldman
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Helen Toledano
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Ira Winer
- Wayne State University and Karmanos Cancer Institute, Detroit, MI, USA
| | - Isabelle Scheers
- Division of Pediatric Gastroenterology and Hepatology, Cliniques Universitaires Saint-Luc, IREC Universite Catholique de Louvain, Brussels, Belgium
| | - Ivana Fedorakova
- Clinic of Pediatric Oncology and Hematology, University Children's Hospital, Banská Bystrica, Slovakia
| | - Jack M Su
- Department of Pediatrics, Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, Houston, TX, USA
| | - Jaime Vengoechea
- Associate Professor of Human Genetics, Emory University, Atlanta, GA, USA
| | - Jaroslav Sterba
- Pediatric Oncology Department, University Hospital Brno, Masaryk Univerzity, Faculty of Medicine, Brno, Czech Republic
| | - Jeffrey Knipstein
- Division of Pediatric Hematology/Oncology/Blood and Marrow Transplant, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jordan R Hansford
- Michael Rice Children's Hematology and Oncology Centre, Women's and Children's Hospital, Adelaide, SA, Australia; South Australia Health and Medical Research Institute Adelaide, SA, Australia; South Australia Immunogenomics Cancer Institute, University of Adelaide, Adelaide, SA, Australia
| | | | - Kanika Bhatia
- Children's Cancer Centre, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Kevin J Bielamowicz
- Department of Pediatrics, Division of Hematology/Oncology, University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, AR, USA
| | - Khurram Minhas
- Division of Histopathology, Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Kim E Nichols
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Kristina A Cole
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lynette Penney
- Division of Medical Genetics, Department of Pediatrics, IWK Health Centre, Halifax, NS, Canada
| | | | - Magnus Sabel
- Department of Pediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | | | - Matthew Miller
- Division of Hematology and Oncology, Oregon Health & Science University, Portland, OR, USA
| | | | - Maura Massimino
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Mazin F Al-Jadiry
- College of Medicine, University of Baghdad, Paediatric Oncology Unit, Baghdad, Iraq
| | | | - Michael Osborn
- Michael Rice Children's Hematology and Oncology Centre, Women's and Children's Hospital, Adelaide, SA, Australia
| | - Michael P Link
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Michal Zapotocky
- Department of Paediatric Haematology and Oncology, University Hospital Motol and Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Najma Shaheen
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | | | - Nicolas Waespe
- Division of Pediatric Oncology and Hematology, Department of Pediatrics, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Nobuko Hijiya
- Pediatric Hematology Oncology and Stem Cell Transplant, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Olfat Ahmad
- Hopp Children's Cancer Center, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Omar Chamdine
- Department of Pediatric Hematology Oncology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Paromita Roy
- Department of Pathology, Tata Medical Center, Rajarhat, Kolkata, India
| | - Pavel N Pichurin
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA
| | - Per Nyman
- Crown Princess Victoria Children's Hospital, Linköping University Hospital, Linköping, Sweden; Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Rachel Pearlman
- Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | | | - Reghu K Sukumaran
- Department of Pediatric Hemato-oncology, Tata Medical Center, Kolkata, India
| | - Rejin Kebudi
- Department of Pediatric Hematology-Oncology, Istanbul University, Oncology Institute, Istanbul, Türkiye
| | - Rina Dvir
- Department of Pediatric Hemato-Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Robert Raphael
- UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
| | - Ronit Elhasid
- Department of Pediatric Hemato-Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Rose B McGee
- St Jude Children's Research Hospital, Memphis, TN, USA
| | - Rose Chami
- Division of Pathology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Ryan Noss
- Center for Personalized Genetic Healthcare, Cleveland Clinic, Cleveland, OH, USA
| | - Ryuma Tanaka
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Salmo Raskin
- Department of Pediatrics, Federal University of Parana, Curitiba, Parana
| | - Santanu Sen
- Department of Pediatric Hematology, Oncology, and Bone Marrow Transplant, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - Scott Lindhorst
- Department of Neurosurgery, Division of Neuro-Oncology, Medical University of South Carolina, Charleston, SC, USA
| | - Sebastien Perreault
- Division of Child Neurology, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Shani Caspi
- Sheba Medical Center, Cancer Research Center, Tel Hashomer, Israel
| | - Shazia Riaz
- Department of Hematology and Oncology, The Children's Hospital and University of Child Health Sciences, Lahore, Pakistan
| | - Shlomi Constantini
- Department of Pediatric Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Sophie Albert
- Cancer Axis, Lady Davis Institute, Jewish General Hospital, Montreal, QC Canada
| | | | - Stefan Bielack
- Padiatrie 5 (Onkologie, Hamatologie, Immunologie), Zentrum fur Kinder-, Jugend- und Frauenmedizin, Stuttgart Cancer Center, Klinikum Stuttgart-Olgahospital, Stuttgart, Germany
| | - Stefano Chiaravalli
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stuart Louis Cramer
- Department of Pediatric Hematology/Oncology, Prisma Health, Columbia, SC, USA
| | - Sumita Roy
- Central Michigan University, Mount Pleasant, MI, USA; Division of Genetics, Genomic & Metabolic Disorders, Pediatric Cancer Genetics Clinic, Children's Hospital of Michigan, Detroit, MI, USA
| | - Suzanne Cahn
- Winship Cancer Institute, Emory University Hospital, Atlanta, GA, USA
| | - Suzanne Penna
- Division of Rehabilitation Neuropsychology, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Tariq Ghafoor
- Department of Hematology and Stem Cell Transplant, Armed Forces Bone Marrow Transplant Center, National Institute of Blood and Marrow Transplant, Rawalpindi, Pakistan
| | - Uzma Imam
- Pediatric Oncology Department, National Institute of Child Health, Karachi, Pakistan
| | - Valerie Larouche
- Department of Hematology-Oncology, CHU de Quebec-Universite Laval, Quebec, QC, Canada
| | | | - William D Foulkes
- Departments of Oncology and Human Genetics, McGill University Health Centre, Cancer Genetics Program, Montreal, QC, Canada
| | - Yi Yen Lee
- Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Paul C Nathan
- Division of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Yosef E Maruvka
- Faculty of Biotechnology and Food Engineering, The Lokey Center for Life Science and Engineering, TECHNION-Israel Institute of Technology, Haifa, Israel
| | - Mary-Louise C Greer
- Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Carol Durno
- Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada
| | - Adam Shlien
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Birgit Ertl-Wagner
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada; Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Anita Villani
- Division of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - David Malkin
- Division of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Cynthia Hawkins
- Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Eric Bouffet
- Division of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Anirban Das
- Arthur and Sonia Labatt Brain Tumor Research Centre, Toronto, ON, Canada; Division of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Uri Tabori
- Arthur and Sonia Labatt Brain Tumor Research Centre, Toronto, ON, Canada; Division of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada.
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Mushtaq N, Qureshi BM, Javed G, Sheikh NA, Bakhshi SK, Laghari AA, Enam SA, Anwar SSM, Hilal K, Kabir A, Ahmad A, Goraya A, Mistry AS, Rashid A, Maaz AUR, Munawar MA, Khan AA, Bashir F, Hashmi H, Saeed K, Khandwala K, Rehman L, Dewan MC, Khan MS, Karim MU, Shaheen N, Zia N, Yasmeen N, Mahmood R, Memon RAR, Kirmani S, Resham S, Kadri S, Riaz S, Hamid SA, Ghafoor T, Imam U, Mushtaq YR, Rana ZA, Bouffet E, Minhas K. Capacity building for pediatric neuro-oncology in Pakistan- a project by my child matters program of Foundation S. Front Oncol 2024; 14:1325167. [PMID: 38487721 PMCID: PMC10938908 DOI: 10.3389/fonc.2024.1325167] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/17/2024] [Indexed: 03/17/2024] Open
Abstract
Introduction Initiated in June 2019, this collaborative effort involved 15 public and private sector hospitals in Pakistan. The primary objective was to enhance the capacity for pediatric neuro-oncology (PNO) care, supported by a My Child Matters/Foundation S grant. Methods We aimed to establish and operate Multidisciplinary Tumor Boards (MTBs) on a national scale, covering 76% of the population (185.7 million people). In response to the COVID-19 pandemic, MTBs transitioned to videoconferencing. Fifteen hospitals with essential infrastructure participated, holding monthly sessions addressing diagnostic and treatment challenges. Patient cases were anonymized for confidentiality. Educational initiatives, originally planned as in-person events, shifted to a virtual format, enabling continued implementation and collaboration despite pandemic constraints. Results A total of 124 meetings were conducted, addressing 545 cases. To augment knowledge, awareness, and expertise, over 40 longitudinal lectures were organized for healthcare professionals engaged in PNO care. Additionally, two symposia with international collaborators and keynote speakers were also held to raise national awareness. The project achieved significant milestones, including the development of standardized national treatment protocols for low-grade glioma, medulloblastoma, and high-grade glioma. Further protocols are currently under development. Notably, Pakistan's first pediatric neuro-oncology fellowship program was launched, producing two graduates and increasing the number of trained pediatric neuro-oncologists in the country to three. Discussion The initiative exemplifies the potential for capacity building in PNO within low-middle income countries. Success is attributed to intra-national twinning programs, emphasizing collaborative efforts. Efforts are underway to establish a national case registry for PNO, ensuring a comprehensive and organized approach to monitoring and managing cases. This collaborative initiative, supported by the My Child Matters/Foundation S grant, showcases the success of capacity building in pediatric neuro-oncology in low-middle income countries. The establishment of treatment protocols, fellowship programs, and regional tumor boards highlights the potential for sustainable improvements in PNO care.
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Affiliation(s)
- Naureen Mushtaq
- Peadiatric Oncology Section, Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Bilal Mazhar Qureshi
- Radiation Oncology Section, Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Gohar Javed
- Neurosurgery Section, Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Nabeel Ashfaque Sheikh
- Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Karachi, Pakistan
| | - Saqib Kamran Bakhshi
- Neurosurgery Section, Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Altaf Ali Laghari
- Neurosurgery Section, Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Syed Ather Enam
- Neurosurgery Section, Department of Surgery, Aga Khan University, Karachi, Pakistan
| | | | - Kiran Hilal
- Department of Radiology, Aga Khan University, Karachi, Pakistan
| | - Arsalan Kabir
- Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Alia Ahmad
- Department of Pediatric Oncology, Children’s Hospital and Institute of Child Health, Lahore, Pakistan
| | - Amber Goraya
- Department of Radiology Children’s Hospital and Institute of Child Health, Lahore, Pakistan
| | | | - Aqeela Rashid
- Department of Pediatric Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | | | - Muhammad Atif Munawar
- Department of Radiation Oncology, Northwest General Hospital and Research Center, Peshawar, Pakistan
| | - Atiq Ahmed Khan
- Department of Neurosurgery, Ruth K. M. Pfau Civil Hospital, Karachi, Pakistan
| | | | - Hina Hashmi
- Jinnah Postgraduate Medical Centre, Aga Khan University, Karachi, Pakistan
| | - Kamran Saeed
- Jinnah Postgraduate Medical Centre, Aga Khan University, Karachi, Pakistan
| | | | - Lal Rehman
- Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Michael C. Dewan
- Vanderbilt University Medical Center, Nashville, TN, United States
| | - Muhammad Saghir Khan
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Madinah, Saudi Arabia
| | - Muneeb uddin Karim
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Najma Shaheen
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Nida Zia
- Indus Hospital & Health Network, Karachi, Pakistan
| | - Nuzhat Yasmeen
- Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Raheela Mahmood
- Atomic Energy Medical Centre, Aga Khan University, Karachi, Pakistan
| | | | | | | | - Shazia Kadri
- Jinnah Medical College and Teaching Hospital, Peshawar, Pakistan
| | - Shazia Riaz
- Children’s Hospital and Institute of Child Health, Lahore, Pakistan
| | | | | | - Uzma Imam
- Child Aid Association, National Institute of Child Health, Karachi, Pakistan
| | | | - Zulfiqar Ali Rana
- Children’s Hospital & The Institute of Child Health Multan, Multan, Pakistan
| | - Eric Bouffet
- The Hospital for Sick Children (SickKids), Toronto, ON, Canada
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6
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Memon F, Humayun KN, Riaz Q, Arif M, Huda NU, Laghari AA, Hilal K, Mushtaq N. Pediatric craniopharyngioma: a 20-year study on epidemiological features, clinical presentation, and survival outcomes in a tertiary care center from LMIC. Childs Nerv Syst 2024; 40:427-434. [PMID: 37837454 DOI: 10.1007/s00381-023-06177-8] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/30/2023] [Indexed: 10/16/2023]
Abstract
INTRODUCTION Craniopharyngioma constitutes approximately 10% of primary brain tumors in children. It can cause considerable morbidity and mortality due to the local aggressiveness of the tumor itself or its management affecting the hypothalamus-pituitary axis and optic pathway involvement. There is very scarce data available from LMIC which makes the management controversial where multidisciplinary teams are already not available in most of the centers. This is a single-center cross-sectional retrospective review of 20-year record of 49 patients with craniopharyngioma treated between 2001 and 2020 at Aga Khan University Hospital, a tertiary care center in Karachi, Pakistan. METHODS We have assessed the epidemiological data of children presenting with the diagnosis of craniopharyngioma, treatment modalities used, and neurological, endocrine, and hypothalamic complications in these patients. The assessment involved a retrospective review of medical records and medical follow-up. RESULTS Out of a total of 49 patients, 26 (53%) were male, and 23 (46.9%) were female. The mean age was 9.5 years (SD ± 4.5 years). Most common symptoms at initial presentation were headache 41 (83.6%), visual deficit 40 (81.6%), nausea and vomiting 26 (53%), and endocrine abnormalities 16 (32%). Treatment modalities used at our center include gross total resection 11 (22%) and subtotal resection 38 (77%) out of total, while 6 (12.2%) patients received intracystic interferon. Histopathologic findings of the majority of patients (40 (81%)) revealed an adamantinomatous type of tumor. Only 23 (46.9%) children followed in clinic post-op. Median follow-up after craniopharyngioma presentation was 5 years (± 2.1 SD, range: 2-10 years). Pituitary hormone deficiencies (98%) and visual disturbances (75%) were the most common long-term health conditions observed. CONCLUSIONS Since pituitary hormone deficiencies and visual disturbance were the most common long-term health conditions observed in our study, these patients require a multidisciplinary team follow-up to improve their quality of life.
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Affiliation(s)
- Fozia Memon
- Department of Pediatrics, Aga Khan University, Karachi, Pakistan
| | | | - Quratulain Riaz
- Department of Pediatric Oncology, Indus Hospital, Karachi, Pakistan
| | - Muzna Arif
- Department of Pediatrics, Aga Khan University, Karachi, Pakistan
| | | | - Altaf Ali Laghari
- Section of Neurosurgery, Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Kiran Hilal
- Department of Radiology, Aga Khan University, Karachi, Pakistan
| | - Naureen Mushtaq
- Department of Oncology, Aga Khan University, Karachi, Pakistan.
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7
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Tang AR, Haizel-Cobbina J, Khalid MU, Peter-Okaka UI, Prosak OL, Mushtaq N, Dewan MC. Global pediatric craniopharyngioma management modalities and outcomes. Childs Nerv Syst 2024; 40:47-56. [PMID: 37466685 DOI: 10.1007/s00381-023-06088-8] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 07/17/2023] [Indexed: 07/20/2023]
Abstract
INTRODUCTION Pediatric craniopharyngioma is a complex pathology, with optimal management involving a multidisciplinary approach and thoughtful care coordination. To date, no studies have compared various treatment modalities and outcomes described in different global regions. We conducted a comprehensive systematic review to compare demographics, clinical presentation, treatment approach and outcomes of children diagnosed with craniopharyngioma globally. METHODS A systematic review was conducted in accordance with the Preferred Reporting Item for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Search terms included "craniopharyngioma" and country-specific terms. Inclusion criteria included full-text studies published between 2000-2022, primarily examining pediatric patients 18-years old or younger diagnosed with craniopharyngioma, and reporting management and outcomes of interest. Data extracted included country of origin, demographical data, initial presentation and treatment modality, and outcomes. Descriptive statistics and between-group comparisons based on country of origin were performed. RESULTS Of 797 search results, 35 articles were included, mostly originating from high-income countries (HIC) (n = 25, 71.4%). No studies originated from low-income countries (LIC). When comparing HIC to middle-income countries (MIC), no differences in patient demographics were observed. No differences in symptomatology at initial presentation, tumor type, surgical approach or extent of surgical resection were observed. HIC patients undergoing intracystic therapy were more likely to receive bleomycin (n = 48, 85.7%), while the majority of MIC patients received interferon therapy (n = 10, 62.5%). All MIC patients undergoing radiation therapy underwent photon therapy (n = 102). No statistically significant differences were observed in postoperative complications or mean follow-up duration between HIC and MIC (78.1 ± 32.2 vs. 58.5 ± 32.1 months, p = 0.241). CONCLUSION Pediatric craniopharyngioma presents and is managed similarly across the globe. However, no studies originating from LICs and resource-poor regions examine presentation and management to date, representing a significant knowledge gap that must be addressed to complete the global picture of pediatric craniopharyngioma burden and management.
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Affiliation(s)
- Alan R Tang
- Vanderbilt University School of Medicine, TN, Nashville, USA
| | - Joseline Haizel-Cobbina
- Department of Neurological Surgery, Division of Pediatric Neurological Surgery, Vanderbilt University Medical Center, 2200 Children's Way, 9226 Doctors Office Tower, TN, 37232-9557, Nashville, USA
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Muhammad Usman Khalid
- Department of Neurological Surgery, University of Kentucky College of Medicine, Lexington, KY, USA
| | | | - Olivia L Prosak
- Vanderbilt University School of Medicine, TN, Nashville, USA
| | - Naureen Mushtaq
- Department of Oncology, Section of Pediatric Oncology, Aga Khan University Hospital, Karachi, Pakistan
| | - Michael C Dewan
- Department of Neurological Surgery, Division of Pediatric Neurological Surgery, Vanderbilt University Medical Center, 2200 Children's Way, 9226 Doctors Office Tower, TN, 37232-9557, Nashville, USA.
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA.
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8
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Mushtaq N, Ul Ain R, Hamid SA, Bouffet E. Evolution of Systemic Therapy in Medulloblastoma Including Irradiation-Sparing Approaches. Diagnostics (Basel) 2023; 13:3680. [PMID: 38132264 PMCID: PMC10743079 DOI: 10.3390/diagnostics13243680] [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: 09/20/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023] Open
Abstract
The management of medulloblastoma in children has dramatically changed over the past four decades, with the development of chemotherapy protocols aiming at improving survival and reducing long-term toxicities of high-dose craniospinal radiotherapy. While the staging and treatment of medulloblastoma were until recently based on the modified Chang's system, recent advances in the molecular biology of medulloblastoma have revolutionized approaches in the management of this increasingly complex disease. The evolution of systemic therapies is described in this review.
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Affiliation(s)
- Naureen Mushtaq
- Division of Pediatric Oncology, Department of Oncology, Aga Khan University, Karachi 74800, Pakistan;
| | - Rahat Ul Ain
- Department of Pediatric Hematology/Oncology & Bone Marrow Transplant, University of Child Health Sciences, Children’s Hospital, Lahore 54600, Pakistan;
| | - Syed Ahmer Hamid
- Department of Pediatric Hematology and Oncology, Indus Hospital & Health Network, Karachi 74800, Pakistan;
| | - Eric Bouffet
- Global Neuro-Oncology Program, Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, St. Jude Global, Memphis, TN 38105, USA
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9
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Mustansir F, Baig E, Angez M, Minhas K, Mushtaq N, Enam SA. Paediatric choroid plexus carcinoma: a retrospective case series from Karachi. J PAK MED ASSOC 2023; 73:2483-2487. [PMID: 38083939 DOI: 10.47391/jpma.6452] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The objective of this study is to report clinical, radiological, and histopathological characteristics of three paediatric patients diagnosed as Choroid plexus carcinoma seen at our hospital, between 2015 and 2020. Three patients were diagnosed with choroid plexus carcinomas between 2015 and 2018. The mean age at diagnosis was 1.3 years (range 8 months to 1.5 years). All the three patients had subtotal resection and received adjuvant chemotherapy. One patient also received adjuvant radiotherapy. Despite these treatment measures, residual disease was noted in all three patients and two patients were subsequently treated on palliative care grounds. The average duration of follow-up after the first surgery for all three patients was approximately 33 months. Attaining satisfactory outcome in patients with CPC is challenging. Our case series reflects the difficulty in achieving gross total resection and ensuring that the disease does not recur.
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Affiliation(s)
| | - Erum Baig
- Aga Khan University, Karachi, Pakistan
| | - Meher Angez
- 4th Year MBBS Student, Aga Khan University, Karachi, Pakistan
| | - Khurram Minhas
- Department of Pathology, Aga Khan University, Karachi, Pakistan
| | - Naureen Mushtaq
- Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Syed Ather Enam
- Department of Surgery, Aga Khan University, Karachi, Pakistan
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10
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Amayiri N, Spitaels A, Zaghloul M, Figaji A, Cavalheiro S, Muller HL, Elhassan M, Parkes J, Mushtaq N, Beltagy ME, Yousef YA, Esiashvili N, Sullivan M, da Costa MD, Dastoli P, Mubarak F, Bartels U, Chamdine O, Davidson A, Musharbash A, Alcasabas P, Bouffet E, Bailey S. SIOP PODC-adapted treatment guidelines for craniopharyngioma in low- and middle-income settings. Pediatr Blood Cancer 2023; 70:e28493. [PMID: 32790146 DOI: 10.1002/pbc.28493] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 05/21/2020] [Accepted: 05/26/2020] [Indexed: 12/16/2022]
Abstract
Pediatric craniopharyngioma is a rare tumor with excellent survival but significant long-term morbidities due to the loco-regional tumor growth or secondary to its treatment. Visual impairment, panhypopituitarism, hypothalamic damage, and behavioral changes are among the main challenges. This tumor should be managed under the care of a multidisciplinary team to determine the optimum treatment within the available resources. This is particularly important for low middle-income countries where resources are variable. This report provides risk-stratified management guidelines for children diagnosed with craniopharyngioma in a resource-limited setting.
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Affiliation(s)
- Nisreen Amayiri
- Pediatric Oncology Department, King Hussein Cancer Center, Amman, Jordan
| | - Ariane Spitaels
- Division of Endocrinology, Department of Pediatric Medicine, Faculty of Health Sciences, UCT, Cape Town, South Africa
| | - Mohamed Zaghloul
- Radiation Oncology Department, National Cancer Institute, Cairo University and Children's Cancer Hospital, Cairo, Egypt
| | - Anthony Figaji
- Department of Neurosurgery, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa
| | - Sergio Cavalheiro
- Division of Neurosurgery, Pediatric Oncology Institute/GRAACC, Universidade Federal de São Paulo, Sao Paulo, Brazil
- Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Hermann L Muller
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children's Hospital, Klinikum Oldenburg AöR, Oldenburg, Germany
| | - Moawia Elhassan
- Clinical Oncology department, National Cancer Institute, University of Gezira, Wad Madani, Sudan
| | - Jeannette Parkes
- Department of Radiation Oncology, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Naureen Mushtaq
- Department of Pediatric Hematology and Oncology, Aga Khan University Hospital, Karachi, Pakistan
| | - Mohamed El Beltagy
- Department of Neurosurgery, Kasr Al-Ainy School of Medicine, Children's Cancer Hospital Egypt, Cairo University, Cairo, Egypt
| | - Yacoub A Yousef
- Ophthalmology division/ Surgery department, King Hussein Cancer Center, Amman, Jordan
| | - Natia Esiashvili
- Radiation Oncology Department, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Michael Sullivan
- Department of Pediatric Hematology and Oncology, Royal Hospital for Sick Children, Melbourne, Victoria, Australia
| | - Marcos Devanir da Costa
- Division of Neurosurgery, Pediatric Oncology Institute/GRAACC, Universidade Federal de São Paulo, Sao Paulo, Brazil
- Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Patricia Dastoli
- Division of Neurosurgery, Pediatric Oncology Institute/GRAACC, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - Fatima Mubarak
- Radiology Department, Aga Khan University, Karachi, Pakistan
| | - Ute Bartels
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Canada
| | - Omar Chamdine
- Department of Pediatric Hematology Oncology and stem cell transplantation, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Alan Davidson
- Hematology-Oncology Service, Red Cross Children's Hospital, Department of Pediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Awni Musharbash
- Neurosurgery division/Surgery department, King Hussein Cancer Center, Amman, Jordan
| | - Patricia Alcasabas
- University of the Philippines-Philippine General Hospital, Manila, the Philippines
| | - Eric Bouffet
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Canada
| | - Simon Bailey
- Department of Pediatric Oncology, Great North Children's Hospital, Newcastle upon Tyne, UK
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Bashir F, Qureshi BM, Minhas K, Tabori U, Bouffet E, Hawkins C, Enam A, Mushtaq N. Pakistan National Guidelines for Pediatric High-Grade Gliomas. Pak J Med Sci 2023; 39:1548-1554. [PMID: 37680835 PMCID: PMC10480739 DOI: 10.12669/pjms.39.5.6300] [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: 03/04/2022] [Revised: 06/15/2022] [Accepted: 05/26/2023] [Indexed: 09/09/2023] Open
Abstract
Pediatric high-grade glioma (pHGG) is highly malignant central nervous system tumor and constitute 10% of the pediatric gliomas. Effective treatment needs a functioning multi-disciplinary team including pediatric neuro oncologist, neurosurgeon, neuroradiologist, neuropathologist and radiation oncologist. Despite surgical resection, radiotherapy and chemotherapy, most HGG will recur resulting in early death. A significant proportion of HGG occurs in context of cancer predisposition syndromes like Constitutional Mismatch Repair Deficiency (CMMRD) also known as Biallelic Mismatch Repair Deficiency (bMMRD) characterized by high mutational burden. The incidence of HGG with CMMRD is one per million patients. bMMRD is caused by homozygous germline mutations in one of the four Mis Match Repair (MMR) genes (PMS2, MLH1, MSH2, and MSH6). The use of TMZ is now avoided in CMMRD related HGG due to its limited response and known ability to increase the accumulation of somatic mutations in these patients, increasing the risk of secondary tumors. HGG should be managed under the care of multidisciplinary team to receive optimum treatment. This is particularly important for low middle-income countries (LMIC) with limited resources like Pakistan.
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Affiliation(s)
- Farrah Bashir
- Dr. Farrah Bashir, FCPS Aga Khan University Hospital, Karachi, Pakistan
| | | | - Khurram Minhas
- Dr. Khurram Minhas, FCPS Aga Khan University Hospital, Karachi, Pakistan
| | - Uri Tabori
- Dr. Uri Tabori, MD, PHD The Hospital for Sick Children (SickKids), Toronto, Canada
| | - Eric Bouffet
- Dr. Eric Bouffet, MD The Hospital for Sick Children (SickKids), Toronto, Canada
| | - Cynthia Hawkins
- Dr. Cynthia Hawkins, MD The Hospital for Sick Children (SickKids), Toronto, Canada
| | - Ather Enam
- Dr. Ather Enam, MD Aga Khan University Hospital, Karachi, Pakistan
| | - Naureen Mushtaq
- Dr. Naureen Mushtaq, FCPS Aga Khan University Hospital, Karachi, Pakistan
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Zahid N, Enam SA, Urooj F, Martins RS, Mårtensson T, Mårtensson A, Mushtaq N, Kausar F, Moochhala M, Mughal MN, Altaf S, Kirmani S, Brown N. Socio-demographic and antenatal risk factors of brain tumor in children and young people: A matched case-control study from Karachi, Pakistan. J Public Health Res 2023; 12:22799036231197185. [PMID: 37700932 PMCID: PMC10493064 DOI: 10.1177/22799036231197185] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 07/26/2023] [Indexed: 09/14/2023] Open
Abstract
Background Brain tumors are a common cause of morbidity, disability, cognitive deterioration and mortality in children, even after treatment. Little is know about the specific causes. The study aimed to assess potential socio-demographic and antenatal factors in primary brain tumor (PBTs) in children and young people (CYP) in Karachi, Pakistan. Designs and methods A single center hospital based matched case control study in Karachi, Pakistan. Cases were defined as CYP aged between 5 and 21 years with any histological type and grade of primary brain tumor of any histology, stage or grade. Data were collected from parents of 244 patients at the selected center between 2017 and 2021 via telephonic interview. Controls were 5-21 years old CYP admitted with non-oncological diagnoses matched on age and sex. Matched Odds Ratios for predictors of brain tumor in children were derived. Those of statistical significance were included in a multivariable logistic regression model. Results In the adjusted model, lower paternal education (matched adjusted odds ratio (maOR) 2.46; 95% CI 1.09-5.55), higher household monthly income (maOR 3.4; 95% CI 1.1-10.2), antenatal paternal use of addictive substances (maOR 19.5; 95% CI 2.1-179.8), and antenatal maternal use of analgesics during pregnancy (maOR 3.0; 95% CI 1.2-7.9) were all independently predictive of brain tumors. Conclusion This matched case-control study found novel associations between maternal use of analgesics, paternal use of addictive substances, higher household income, and lower paternal education and Primary Brain Tumors in Children and Young People. Longitudinal multicenter studies will be required to test these associations prospectively.
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Affiliation(s)
- Nida Zahid
- Department of Surgery, Aga Khan University, Karachi, Pakistan
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Syed Ather Enam
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Faiza Urooj
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Russell Seth Martins
- Center for Clinical Best Practices, Clinical and Translational Research Incubator, Aga Khan University, Karachi, Pakistan
| | - Thomas Mårtensson
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Andreas Mårtensson
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Naureen Mushtaq
- Department of Pediatric Oncology, Aga Khan University, Karachi, Pakistan
| | - Faiza Kausar
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Mariya Moochhala
- Department of Psychiatry, Aga Khan University, Karachi, Pakistan
| | | | - Sadaf Altaf
- Department of Pediatric Oncology, Aga Khan University, Karachi, Pakistan
| | - Salman Kirmani
- Division of Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Nick Brown
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Department of Pediatrics, Aga Khan University, Karachi, Pakistan
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Pervez S, Jabbar AA, Haider G, Qureshi MA, Ashraf S, Lateef F, Khurshid M, Bashir I, Zaidi M, Mushtaq N, Fadoo Z, Quraishy MS, Yaqoob N, Alam E, Qureshi H. Karachi Cancer Registry (KCR): Consolidated Data of 5-years 2017-2021. J Coll Physicians Surg Pak 2023; 33:560-565. [PMID: 37190693 DOI: 10.29271/jcpsp.2023.05.560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 04/29/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To collect and analyse epidemiologic data of all malignancies by age group and gender for the Karachi population to estimate the cancer incidence of 5-years (2017-2021) and identify major risk factors for setting priorities towards cancer control programs. STUDY DESIGN Observational study. Place and Duration of the Study: Karachi Cancer Registry (KCR) Secretariat, Pakistan Health Research Council (PHRC), JPMC, Karachi, from 2017-2021. METHODOLOGY Cancer data of seven tertiary care hospitals of Karachi submitted to KCR during the study period were analysed including age, gender, date of first contact, primary site and ICD coding. All the data was cleaned, merged, and analysed. All patients 0-14 years were classified as 'children', all aged 15-19 years were classified as 'adolescents', and those age 20-years and above as 'adults'. Age standardised incidence rates (ASIR) were determined for both genders. RESULTS During the last five years (2017-2021), a total of 65,886 malignant cases were received. The distributions seen amongst males and females were 33,510 (51%) and 32,376 (49%), respectively with 60,145 (91.3%) tumours found in adults (≥20 years), 4844 (7.3%) in children, and 897 (1.4%) in adolescents. The three most common tumour sites were oral, liver, and colorectal in males; breast, oral and ovary in females; bone, brain and connective tissue in adolescents; and leukaemia, brain and bone in children. The overall ASIR (%) in males was 89.20 for adults, 9.19 for children, and 1.61 for adolescents. The overall ASIR (%) in females was 93.44 for adults, 5.45 for children, and 1.11 for adolescents. CONCLUSION Oral cancer, a largely preventable cancer is the leading cancer in males while breast cancer is the leading cancer in females followed by oral cancer. In adolescents and children, the incidence closely matches most of the world. KEY WORDS Karachi, Cancer registry, Oral cancer, Breast cancer, Age-standerdised ratio.
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Affiliation(s)
- Shahid Pervez
- Department of Pathology & Laboratory Medicine, The Aga Khan University Hospital, Karachi, Pakistan
- Department of Oncology, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
- Department of Pathology, Dow University of Health Sciences, Karachi, Pakistan
- Department of Pediatric Oncology, Indus Hospital, Karachi, Pakistan
- Department of Histopathology, Ziauddin University Hospital, Karachi, Pakistan
- Department of Oncology, Zainab Pujwani Hospital, Karachi, Pakistan
- Department of Oncology, Baqai University Hospital, Karachi, Pakistan
- Department of Histopathology, Indus Hospital, Karachi, Pakistan
- Department of Surgery, Dow University of Health Sciences, Karachi, Pakistan
- Department of Pakistan Health Research Council Research Centre, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Adnan A Jabbar
- Department of Oncology, The Aga Khan University Hospital, Karachi, Pakistan
| | | | | | | | | | - Muhammad Khurshid
- Department of Oncology, The Aga Khan University Hospital, Karachi, Pakistan
| | | | | | - Naureen Mushtaq
- Department of Oncology, The Aga Khan University Hospital, Karachi, Pakistan
| | - Zehra Fadoo
- Department of Oncology, The Aga Khan University Hospital, Karachi, Pakistan
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Duffy C, Santana V, Inaba H, Jeha S, Pauley J, Sniderman L, Ghara N, Mushtaq N, Narula G, Bhakta N, Rodriguez-Galindo C, Brandt H. Evaluating blinatumomab implementation in low- and middle-income countries: a study protocol. Implement Sci Commun 2022; 3:62. [PMID: 35690878 PMCID: PMC9187890 DOI: 10.1186/s43058-022-00310-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/18/2022] [Indexed: 11/12/2022] Open
Abstract
Background The recent implementation of novel therapies has accelerated progress in pediatric cancer care. Despite the significantly poorer survival of patients in low- and middle-income countries (LMICs), administation complexities and other significant resource barriers have limited the translation of these novel therapies in these regions. This study aims to develop a model that can be used to support the implementation of novel therapies, such as blinatumomab (bispecific antibody therapy for B-cell acute lymphoblastic leukemia [B-ALL]) in LMIC centers, with the long-term goal of developing an implementation framework for similar future efforts. Methods In this study, mixed methods will be applied to understand the key contextual considerations that can be accounted for through a training program and prospectively designed implementation activities. The Consolidated Framework for Implementation Research will guide the activities related to implementation evaluation in parallel with a drug donation program. A multidisciplinary research team comprising high- and low-middle income healthcare professionals, industry, and implementation scientists has been assembled with the common goal of improving safe access to blinatumomab. To assess the factors affecting blinatumomab administration, semi-structured interviews with diverse collaborators and quantitative assessments of organizational characteristics will be conducted, together with quantitative and qualitative assessments of feasibility, acceptability, appropriateness, and cost of blinatumomab implementation. A quantitative assessment of stakeholder perceptions of different implementation strategies used as part of the multifaceted approach will also be performed. Finally, we will examine the key domains and processes used and construct the implementation roadmap for translation of novel therapies. Discussion This study will rigorously develop an implementation roadmap for translation of novel therapies in low-resource settings. The knowledge gained in the formative assessment will reveal the priority areas and key implementation strategies. Thereby, the resultant roadmap will facilitate future scale-out strategies for novel therapies in LMICs, thus increasing access, building capacity for management, and ultimately improving the care for children in LMICs.
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Hamid SA, Zia N, Maqsood S, Rafiq N, Fatima M, Syed Y, Tabori U, Bartels U, Hawkins C, Huang A, Ramsawami V, Mushtaq N, Bouffet E. Impact of dedicated pediatric neuro-oncological services in a developing country: A single-institution, Pakistani experience. Pediatr Blood Cancer 2022; 69:e29887. [PMID: 35856658 DOI: 10.1002/pbc.29887] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 06/21/2022] [Accepted: 06/27/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Brain tumors are the most common solid neoplasms and the second most common malignancy in the pediatric age group. Due to the complexity of their management, pediatric central nervous system (CNS) tumors are not a priority in low- and middle-income countries (LMICs). METHODS In an attempt to improve the survival rate and overall care, we introduced a dedicated pediatric neuro-oncology service in our institute and evaluated its impact by dividing the pre- and post-era into two cohorts and comparing them: 1998-2013 (16 years: cohort A) and 2014-2019 (6 years: cohort B, after the start of dedicated neuro-oncology services). RESULTS We observed that after the implementation of a proper neuro-oncology service, the proportion of patients treated with curative intent increased, and survival improved in cohort B. The patient volume also increased from 15.5 per year in cohort A to 44.8 per year in cohort B. The percentage of children given radiation therapy also increased significantly, while the proportion of children treated with chemotherapy remained stable. CONCLUSION A dedicated multidisciplinary team trained and knowledgeable in the specialty of pediatric neuro-oncology can enhance and improve outcomes, and supportive care and help can provide good quality of life to children and their families with brain neoplasms.
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Affiliation(s)
- Syed Ahmer Hamid
- Department of Pediatric Hematology and Oncology, Indus Hospital & Health Network, Karachi, Pakistan
| | - Nida Zia
- Department of Pediatric Hematology and Oncology, Indus Hospital & Health Network, Karachi, Pakistan
| | - Sidra Maqsood
- Indus Hospital Research Centre, Indus Hospital & Health Network, Karachi, Pakistan
| | - Naila Rafiq
- Department of Pediatric Hematology and Oncology, Indus Hospital & Health Network, Karachi, Pakistan
| | - Mushkbar Fatima
- Indus Hospital Research Centre, Indus Hospital & Health Network, Karachi, Pakistan
| | - Yumna Syed
- Department of Pediatric Hematology and Oncology, Indus Hospital & Health Network, Karachi, Pakistan
| | - Uri Tabori
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ute Bartels
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cynthia Hawkins
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Annie Huang
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Vijay Ramsawami
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Naureen Mushtaq
- Department of Oncology, The Aga Khan University Hospital, Karachi, Pakistan
| | - Eric Bouffet
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
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16
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Mushtaq N, Mustansir F, Minhas K, Usman S, Qureshi BM, Mubarak F, Bari E, Enam SA, Laghari AA, Javed G, Shamim S, Darbar A, Abbasi AN, Kirmani S, Resham S, Bilal A, Hamid SA, Zia N, Shaheen N, Wali R, Ghafoor T, Imam U, Maaz AUR, Khan S, Laperriere N, Desbrandes F, Dirks P, Drake J, Huang A, Tabori U, Hawkins C, Bartels U, Ramaswamy V, Bouffet E. Building the ecosystem for pediatric neuro-oncology care in Pakistan: Results of a 7-year long twinning program between Canada and Pakistan. Pediatr Blood Cancer 2022; 69:e29726. [PMID: 35484912 DOI: 10.1002/pbc.29726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/01/2021] [Revised: 02/23/2022] [Accepted: 03/02/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Low- and middle-income countries sustain the majority of pediatric cancer burden, with significantly poorer survival rates compared to high-income countries. Collaboration between institutions in low- and middle-income countries and high-income countries is one of the ways to improve cancer outcomes. METHODS Patient characteristics and effects of a pediatric neuro-oncology twinning program between the Hospital for Sick Children in Toronto, Canada and several hospitals in Karachi, Pakistan over 7 years are described in this article. RESULTS A total of 460 patients were included in the study. The most common primary central nervous system tumors were low-grade gliomas (26.7%), followed by medulloblastomas (18%), high-grade gliomas (15%), ependymomas (11%), and craniopharyngiomas (11.7%). Changes to the proposed management plans were made in consultation with expert physicians from the Hospital for Sick Children in Toronto, Canada. On average, 24% of the discussed cases required a change in the original management plan over the course of the twinning program. However, a decreasing trend in change in management plans was observed, from 36% during the first 3.5 years to 16% in the last 3 years. This program also led to the launch of a national pediatric neuro-oncology telemedicine program in Pakistan. CONCLUSIONS Multidisciplinary and collaborative efforts by experts from across the world have aided in the correct diagnosis and treatment of children with brain tumors and helped establish local treatment protocols. This experience may be a model for other low- and middle-income countries that are planning on creating similar programs.
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Affiliation(s)
- Naureen Mushtaq
- Division of Pediatric Oncology, Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Fatima Mustansir
- Division of Pediatric Oncology, Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Khurram Minhas
- Division of Pediatric Oncology, Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Sadia Usman
- Division of Pediatric Oncology, Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Bilal Mazhar Qureshi
- Division of Pediatric Oncology, Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Fatima Mubarak
- Division of Pediatric Oncology, Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Ehsan Bari
- Division of Pediatric Oncology, Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Syed Ather Enam
- Division of Pediatric Oncology, Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Altaf Ali Laghari
- Division of Pediatric Oncology, Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Gohar Javed
- Division of Pediatric Oncology, Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Shahzad Shamim
- Division of Pediatric Oncology, Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Aneela Darbar
- Division of Pediatric Oncology, Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Ahmed Nadeem Abbasi
- Division of Pediatric Oncology, Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Salman Kirmani
- Division of Pediatric Oncology, Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Shahazadi Resham
- Division of Pediatric Oncology, Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Afia Bilal
- Division of Pediatric Oncology, Department of Oncology, Aga Khan University, Karachi, Pakistan
| | | | - Nida Zia
- Indus Children Cancer Hospital, Karachi, Pakistan
| | - Najma Shaheen
- Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan
| | - Rabia Wali
- Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan
| | | | - Uzma Imam
- National Institute of Child Health, Karachi, Pakistan
| | | | - Sara Khan
- The Hospital for Sick Children, Toronto, Canada
| | | | | | - Peter Dirks
- The Hospital for Sick Children, Toronto, Canada
| | - James Drake
- The Hospital for Sick Children, Toronto, Canada
| | - Annie Huang
- The Hospital for Sick Children, Toronto, Canada
| | - Uri Tabori
- The Hospital for Sick Children, Toronto, Canada
| | | | - Ute Bartels
- The Hospital for Sick Children, Toronto, Canada
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17
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Lamoureux AA, Fisher M, Lemelle L, Pfaff E, Kramm C, De Wilde B, Kazanowska B, Hutter C, Pfister SM, Sturm D, Jones D, Orbach D, Pierron G, Raskin S, Drilon A, Diamond E, Harada G, Zapotocky M, Ellezam B, Weil AG, Venne D, Barritault M, Leblond P, Coltin H, Hammad R, Tabori U, Hawkins C, Hansford JR, Meyran D, Erker C, McFadden K, Sato M, Gottardo NG, Dholaria H, Nørøxe DS, Goto H, Ziegler DS, Lin FY, Parsons DW, Lindsay H, Wong TT, Liu YL, Wu KS, Franson AF, Hwang E, Aguilar-Bonilla A, Cheng S, Cacciotti C, Massimino M, Schiavello E, Wood P, Hoffman LM, Cappellano A, Lassaletta A, Van Damme A, Llort A, Gerber NU, Ceruso MS, Bendel AE, Skrypek M, Hamideh D, Mushtaq N, Walter A, Jabado N, Alsahlawi A, Farmer JP, Abadi CC, Mueller S, Mazewski C, Aguilera D, Robison N, O’Halloran K, Abbou S, Berlanga P, Geoerger B, Øra I, Moertel CL, Razis ED, Vernadou A, Doz F, Laetsch TW, Perreault S. HGG-11. Clinical characteristics and clinical evolution of a large cohort of pediatric patients with primary central nervous system (CNS) tumors and tropomyosin receptor kinase (TRK) fusion. Neuro Oncol 2022. [PMCID: PMC9164744 DOI: 10.1093/neuonc/noac079.226] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND: TRK fusions are detected in less than 3% of CNS tumors. Given their rarity, there are limited data on the clinical course of these patients. METHODS: We contacted 166 oncology centers worldwide to retrieve data on patients with TRK fusion-driven CNS tumors. Data extracted included demographics, histopathology, NTRK gene fusion, treatment modalities and outcomes. Patients less than 18 years of age at diagnosis were included in this analysis. RESULTS: Seventy-three pediatric patients with TRK fusion-driven primary CNS tumors were identified. Median age at diagnosis was 2.4 years (range 0.0–17.8) and 60.2 % were male. NTRK2 gene fusions were found in 37 patients (50.7%), NTRK1 and NTRK3 aberrations were detected in 19 (26.0%) and 17 (23.3%), respectively. Tumor types included 38 high-grade gliomas (HGG; 52.1%), 20 low-grade gliomas (LGG; 27.4%), 4 embryonal tumors (5.5%) and 11 others (15.1%). Median follow-up was 46.5 months (range 3-226). During the course of their disease, a total of 62 (84.9%) patients underwent surgery with a treatment intent, 50 (68.5%) patients received chemotherapy, 35 (47.9%) patients received radiation therapy, while 34 (46.6%) patients received NTRK inhibitors (3 as first line treatment). Twenty-four (32.9%) had no progression including 9 LGG (45%) and 9 HGG (23.6%). At last follow-up, only one (5.6%-18 evaluable) patient with LGG died compared to 11 with HGG (35.5%-31 evaluable). For LGG the median progression-free survival (PFS) after the first line of treatment was 17 months (95% CI: 0.0-35.5) and median overall survival (OS) was not reached. For patients with HGG the median PFS was 30 months (95% CI: 11.9-48.1) and median OS was 182 months (95% CI 20.2-343.8). CONCLUSIONS: We report the largest cohort of pediatric patients with TRK fusion-driven primary CNS tumors. These results will help us to better understand clinical evolution and compare outcomes with ongoing clinical trials.
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Affiliation(s)
| | - Michael Fisher
- Children's Hospital of Philadelphia , Philadelphia , USA
| | | | - Elke Pfaff
- Hopp Children's Cancer Center Heidelberg (KiTZ); German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK); Heidelberg University Hospital , Heidelberg , Germany
| | - Christof Kramm
- University Medical Center Göttingen , Göttingen , Germany
| | | | - Bernarda Kazanowska
- Department of Pediatric Hematology/Oncology and BMT, Wroclaw Medical University , Wroclaw , Poland
| | - Caroline Hutter
- St. Anna Children’s Hospital, Depart- ment of Pediatrics, Medical University of Vienna, and St. Anna Children’s Cancer Research Institute (CCRI) , Viennes , Austria
| | - Stefan M Pfister
- Hopp Children's Cancer Center Heidelberg (KiTZ); German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK); Heidelberg University Hospital , Heidelberg , Germany
| | - Dominik Sturm
- Hopp Children's Cancer Center Heidelberg (KiTZ); German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK); Heidelberg University Hospital , Heidelberg , Germany
| | - David Jones
- Hopp Children's Cancer Center Heidelberg (KiTZ); German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK); Heidelberg University Hospital , Heidelberg , Germany
| | | | | | - Scott Raskin
- Cincinnati Children's Hospital Medical Center , Cincinnati , USA
| | | | - Eli Diamond
- Cincinnati Children's Hospital Medical Center , Cincinnati , USA
| | - Guilherme Harada
- Cincinnati Children's Hospital Medical Center , Cincinnati , USA
| | - Michal Zapotocky
- Department of Paediatric Haematology and Oncology, Second Faculty of Medicine, Charles University and University Hospital Motol , Prague , Czech Republic
| | | | | | | | | | - Pierre Leblond
- Institut d'Hématologie et d'Oncologie Pédiatrique and Pluridisciplinar Research in pediatric Oncology for Perspectives in Evaluation Care and Therapy (PROSPECT), Centre Leon Berard , Lyon , France
| | | | - Rawan Hammad
- Hospital for Sick Children , Toronto , Canada
- Hematology department, faculty of Medicine, King Abdulaziz University , Jeddah , Saudi Arabia
| | - Uri Tabori
- Hospital for Sick Children , Toronto , Canada
| | | | - Jordan R Hansford
- Children’s Cancer Centre, Royal Children’s Hospital; Murdoch Children’s Research Institute; Department of Pediatrics, University of Melbourne , Melbourne , Australia
| | - Deborah Meyran
- Children’s Cancer Centre, Royal Children’s Hospital; Murdoch Children’s Research Institute; Department of Pediatrics, University of Melbourne , Melbourne , Australia
| | | | | | - Mariko Sato
- University of Iowa Stead Family Children's Hospital , Iowa City , USA
| | - Nicholas G Gottardo
- Perth Children's Hospital; Brain Tumour Research Programme, Telethon Kids Institute; Paediatrics, School of Medicine, University of Western Australia , Perth , Australia
| | - Hetal Dholaria
- Perth Children's Hospital; Brain Tumour Research Programme, Telethon Kids Institute; Paediatrics, School of Medicine, University of Western Australia , Perth , Australia
| | | | - Hiroaki Goto
- Kanagawa Children’s Medical Center , Yokohama , Japan
| | | | | | | | | | - Tai-Tong Wong
- Taipei Medical University Hospital , Taipei , Taiwan
| | - Yen-Lin Liu
- Taipei Medical University Hospital , Taipei , Taiwan
| | - Kuo-Sheng Wu
- Taipei Medical University Hospital , Taipei , Taiwan
| | | | - Eugene Hwang
- Children's National Hospital, Washington, D.C, USA
| | | | | | - Chantel Cacciotti
- Children’s Hospital, London Health Sciences Centre , London , Canada
| | - Maura Massimino
- Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | | | - Paul Wood
- Monash Children's Hospital, Clayton, Australia. Monash University, Clayton, Australia. The Hudson Institute of Medical Research , Clayton , Australia
| | | | | | | | - An Van Damme
- Cliniques universitaires Saint-Luc , Bruxelle , Belgium
| | - Anna Llort
- Vall d'Hebron Children’s Hospital , Barcelona , Spain
| | - Nicolas U Gerber
- Department of Oncology, University Children's Hospital , Zurich , Switzerland
| | | | | | | | - Dima Hamideh
- American University of Beirut Medical Center , Beirut , Lebanon
| | | | - Andrew Walter
- Nemour Alfred I duPont Hospital for Children , Wilmington , USA
| | - Nada Jabado
- Montreal Children's Hospital, Montréal, Canada
| | | | | | | | | | - Claire Mazewski
- Children's Health Care of Atlanta, Emory University School of Medicine , Atlanta , USA
| | - Dolly Aguilera
- Children's Health Care of Atlanta, Emory University School of Medicine , Atlanta , USA
| | | | | | - Samuel Abbou
- Gustave Roussy Cancer Center, Université Paris-Saclay , Villejuif , France
| | - Pablo Berlanga
- Gustave Roussy Cancer Center, Université Paris-Saclay , Villejuif , France
| | - Birgit Geoerger
- Gustave Roussy Cancer Center, Université Paris-Saclay , Villejuif , France
| | - Ingrid Øra
- Lund University , Lund , Sweden
- Karolinska University Hospital , Stockholm , Sweden
| | | | | | | | - François Doz
- Institut Curie , Paris , France
- University of Paris , Paris , France
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18
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Durno C, Ercan AB, Bianchi V, Edwards M, Aronson M, Galati M, Atenafu EG, Abebe-Campino G, Al-Battashi A, Alharbi M, Azad VF, Baris HN, Basel D, Bedgood R, Bendel A, Ben-Shachar S, Blumenthal DT, Blundell M, Bornhorst M, Bronsema A, Cairney E, Rhode S, Caspi S, Chamdin A, Chiaravalli S, Constantini S, Crooks B, Das A, Dvir R, Farah R, Foulkes WD, Frenkel Z, Gallinger B, Gardner S, Gass D, Ghalibafian M, Gilpin C, Goldberg Y, Goudie C, Hamid SA, Hampel H, Hansford JR, Harlos C, Hijiya N, Hsu S, Kamihara J, Kebudi R, Knipstein J, Koschmann C, Kratz C, Larouche V, Lassaletta A, Lindhorst S, Ling SC, Link MP, Loret De Mola R, Luiten R, Lurye M, Maciaszek JL, MagimairajanIssai V, Maher OM, Massimino M, McGee RB, Mushtaq N, Mason G, Newmark M, Nicholas G, Nichols KE, Nicolaides T, Opocher E, Osborn M, Oshrine B, Pearlman R, Pettee D, Rapp J, Rashid M, Reddy A, Reichman L, Remke M, Robbins G, Roy S, Sabel M, Samuel D, Scheers I, Schneider KW, Sen S, Stearns D, Sumerauer D, Swallow C, Taylor L, Thomas G, Toledano H, Tomboc P, Van Damme A, Winer I, Yalon M, Yen LY, Zapotocky M, Zelcer S, Ziegler DS, Zimmermann S, Hawkins C, Malkin D, Bouffet E, Villani A, Tabori U. Survival Benefit for Individuals With Constitutional Mismatch Repair Deficiency Undergoing Surveillance. J Clin Oncol 2021; 39:2779-2790. [PMID: 33945292 PMCID: PMC8407605 DOI: 10.1200/jco.20.02636] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Constitutional mismatch repair deficiency syndrome (CMMRD) is a lethal cancer predisposition syndrome characterized by early-onset synchronous and metachronous multiorgan tumors. We designed a surveillance protocol for early tumor detection in these individuals.
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Affiliation(s)
- Carol Durno
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada.,Mount Sinai Hospital, The Familial Gastrointestinal Cancer Registry at the Zane Cohen Centre for Digestive Disease, Toronto, ON, Canada
| | - Ayse Bahar Ercan
- The Hospital for Sick Children, The Arthur and Sonia Labatt Brain Tumour Research Centre, Toronto, ON, Canada.,University of Toronto, Institute of Medical Science, Toronto, ON, Canada
| | - Vanessa Bianchi
- The Hospital for Sick Children, The Arthur and Sonia Labatt Brain Tumour Research Centre, Toronto, ON, Canada
| | - Melissa Edwards
- The Hospital for Sick Children, The Arthur and Sonia Labatt Brain Tumour Research Centre, Toronto, ON, Canada
| | - Melyssa Aronson
- Mount Sinai Hospital, The Familial Gastrointestinal Cancer Registry at the Zane Cohen Centre for Digestive Disease, Toronto, ON, Canada
| | - Melissa Galati
- The Hospital for Sick Children, The Arthur and Sonia Labatt Brain Tumour Research Centre, Toronto, ON, Canada.,University of Toronto, Institute of Medical Science, Toronto, ON, Canada
| | - Eshetu G Atenafu
- Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Gadi Abebe-Campino
- Department of Pediatric Hematology-Oncology, Sheba Medical Center, Tel Hashomer, Israel
| | - Abeer Al-Battashi
- Ministry of Health Oman, Child Health Specialist Muscat, Muscat, Oman
| | - Musa Alharbi
- Department of Pediatric Hematology Oncology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Vahid Fallah Azad
- MAHAK Pediatric Cancer Treatment and Research Center (MPCTRC), Tehran, Iran
| | - Hagit N Baris
- Rambam Health Care Campus, The Genetics Institute, Haifa, Israel
| | - Donald Basel
- Medical College of Wisconsin, Pediatrics, Milwaukee, WI
| | | | - Anne Bendel
- Department of Pediatric Hematology-Oncology, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN
| | - Shay Ben-Shachar
- Tel Aviv Sourasky Medical Center, Genetic Institute, Tel Aviv, Israel
| | - Deborah T Blumenthal
- Oncology Division, Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | | | - Miriam Bornhorst
- Children's National Medical Center, Brain Tumor Institute, Washington, DC
| | - Annika Bronsema
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Elizabeth Cairney
- Department of Pediatrics, London Health Sciences Centre, London, ON, Canada
| | - Sara Rhode
- Department of Hematology and Oncology, Cleveland Clinic, Cleveland, OH
| | - Shani Caspi
- Sheba Medical Center, Cancer Research Center, Tel Hashomer, Israel
| | - Aghiad Chamdin
- Michigan State University, College of Human Medicine, Center for Bleeding and Clotting Disorders, East Lansing, MI
| | - Stefano Chiaravalli
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
| | - Shlomi Constantini
- Department of Pediatric Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Bruce Crooks
- Division of Hematology-Oncology, IWK Health Centre, Halifax, NS, Canada
| | - Anirban Das
- Division of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Rina Dvir
- Department of Pediatric Hemato-Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Roula Farah
- Lebanese American University Medical Center-Rizk, Beirut, Lebanon
| | - William D Foulkes
- Deparments of Oncology and Human Genetics, McGill University Health Centre, Cancer Genetics Program, Montreal, QC, Canada
| | | | - Bailey Gallinger
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Sharon Gardner
- Department of Pediatric Hematology-Oncology, NYU Langone Health, New York, NY
| | - David Gass
- Department of Pediatric Hematology and Oncology, Atrium Health, Charlotte, NC
| | - Mithra Ghalibafian
- MAHAK Pediatric Cancer Treatment and Research Center (MPCTRC), Tehran, Iran
| | - Catherine Gilpin
- Children's Hospital of Eastern Ontario, Genetics, Ottawa, ON, Canada
| | - Yael Goldberg
- Department of Oncology, Hadassah Medical Center, Jerusalem, Israel
| | - Catherine Goudie
- Division of Oncology, McGill University Health Centre, Montreal, QC, Canada
| | | | - Heather Hampel
- The Ohio State University Comprehensive Cancer Center, Internal Medicine, Columbus, OH
| | - Jordan R Hansford
- The Royal Children's Hospital Melbourne, Children's Cancer Centre, Parkville, Victoria, Australia
| | - Craig Harlos
- Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Nobuko Hijiya
- Pediatric Hematology Oncology and Stem Cell Transplant, Columbia University Irving Medical Center, New York, NY
| | - Saunders Hsu
- Department of Pediatric Hematology-Oncology, Sutter Health, Sacramento, CA
| | - Junne Kamihara
- Dana-Farber Children's Hospital Cancer Center, Pediatric Oncology, Boston, MA
| | - Rejin Kebudi
- Department of Pediatric Hematology-Oncology, Istanbul University, Fatih, Istanbul, Turkey
| | - Jeffrey Knipstein
- Department of Pediatric Neurology, Medical College of Wisconsin, Milwaukee, WI
| | - Carl Koschmann
- Department of Pediatric Hematology-Oncology, University of Michigan Medical School, Ann Arbor, MI
| | - Christian Kratz
- Department of Pediatric Haematology and Oncology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
| | - Valerie Larouche
- Department of Hematology-Oncology, CHU de Quebec-Universite Laval, Quebec, QC, Canada
| | - Alvaro Lassaletta
- Department of Pediatric Hematology-Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain
| | - Scott Lindhorst
- Department of Hematology-Medical Oncology, Medical University of South Carolina, Charleston, SC
| | - Simon C Ling
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada
| | - Michael P Link
- Department of Pediatrics, Stanford Medicine, Stanford, CA
| | | | - Rebecca Luiten
- Department of Clinical Cancer Genetics, Banner MD Anderson Cancer Center, Gilbert, AZ
| | - Michal Lurye
- Sheba Medical Center at Tel Hashomer, Tel Hashomer, Israel
| | | | | | - Ossama M Maher
- Department of Pediatric Hematology-Oncology, Nicklaus Children's Hospital, Miami, FL
| | - Maura Massimino
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
| | - Rose B McGee
- Saint Jude Children's Research Hospital, Memphis, TN
| | | | - Gary Mason
- Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA
| | - Monica Newmark
- Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL
| | - Garth Nicholas
- Division of Medical Oncology, University of Ottawa, Ottawa, ON, Canada
| | - Kim E Nichols
- Department of Oncology, Saint Jude Children's Research Hospital, Memphis, TN
| | - Theodore Nicolaides
- Department of Pediatric Hematology-Oncology, NYU Langone Health, New York, NY
| | - Enrico Opocher
- Department of Pediatrics, University of Padua, Padova, Veneto, Italy
| | - Michael Osborn
- Paediatric Haematology, Womens and Childrens Hospital (WCH), North Adelaide, South Australia, Australia
| | - Benjamin Oshrine
- Johns Hopkins All Children's Hospital, Cancer and Blood Disorders Institute, Saint Petersburg, FL
| | - Rachel Pearlman
- Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Jan Rapp
- West Virginia University Cancer Institute, Morgantown, WV
| | | | - Alyssa Reddy
- University of California San Francisco, San Francisco, CA
| | - Lara Reichman
- McGill University Health Centre, Montreal, QC, Canada
| | - Marc Remke
- University Hospital Dusseldorf, Dusseldorf, Nordrhein-Westfalen, Germany
| | - Gabriel Robbins
- Department of Pediatric Hematology-Oncology, NYU Langone Health, New York, NY
| | | | - Magnus Sabel
- Department of Pediatrics, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
| | | | - Isabelle Scheers
- Universite Catholique de Louvain La Faculte de Medecine, Bruxelles, Belgium
| | - Kami Wolfe Schneider
- Department of Pediatric Hematology-Oncology, Children's Hospital Colorado, Aurora, CO
| | - Santanu Sen
- Department of Pediatrics, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
| | - Duncan Stearns
- UH Rainbow Babies and Children's Hospital Division of Pediatrics, Pediatric Neuro-oncology, Cleveland, OH
| | - David Sumerauer
- Department of Pediatric Hematology and Oncology, 2nd Faculty of Medicine, University Hospital Motol, Charles University, Prague, Czechia
| | - Carol Swallow
- Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada
| | - Leslie Taylor
- Saint Jude Children's Research Hospital, Memphis, TN
| | | | - Helen Toledano
- Department of Pediatric Hematology Oncology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Patrick Tomboc
- Department of Pediatrics, West Virginia University, Morgantown, WV
| | - An Van Damme
- Department of Pediatric Hematology and Oncology, Universite Catholique de Louvain, Louvain-la-Neuve, Walloon Brabant, Belgium
| | | | - Michal Yalon
- Department of Pediatric Hematology-Oncology, Sheba Medical Center, Tel Hashomer, Israel
| | - Lee Yi Yen
- Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - Shayna Zelcer
- Department of Pediatrics, London Health Sciences Centre, London, ON, Canada
| | - David S Ziegler
- Sydney Children's Hospital Randwick, Kids Cancer Centre, Randwick, New South Wales, Australia
| | - Stefanie Zimmermann
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Cynthia Hawkins
- Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - David Malkin
- Division of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Eric Bouffet
- Division of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Anita Villani
- Division of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Uri Tabori
- Division of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada
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19
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Sajid MI, Altaf S, Mushtaq N, Belgaumi A, Fadoo Z. Pediatric hematology oncology during SARS-CoV-2: A brief communication of 28 patients and changes in clinical practice from a single institute in Pakistan. Pediatr Blood Cancer 2021; 68:e28527. [PMID: 32573930 PMCID: PMC7361147 DOI: 10.1002/pbc.28527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 12/13/2022]
Affiliation(s)
| | - Sadaf Altaf
- Section of Pediatric Oncology & HematologyDepartment of OncologyAga Khan University HospitalKarachiPakistan
| | - Naureen Mushtaq
- Section of Pediatric Oncology & HematologyDepartment of OncologyAga Khan University HospitalKarachiPakistan
| | - Asim Belgaumi
- Section of Pediatric Oncology & HematologyDepartment of OncologyAga Khan University HospitalKarachiPakistan
| | - Zehra Fadoo
- Section of Pediatric Oncology & HematologyDepartment of OncologyAga Khan University HospitalKarachiPakistan
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20
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Abstract
Medulloblastoma is the most common malignant brain tumour in children and is a major cause of mortality and morbidity, particularly in low- and middle-income countries. It has been risk-stratified on the basis of clinical (age, metastasis and extent of resection) and histological subtypes (classic, desmoplastic and anaplastic). However, recently medulloblastoma has been sub-grouped by using a variety of different genomic approaches, such as gene expression profiling, micro-ribonucleic acid profiling and methylation array into 4 groups, namely Wingless, Sonic hedgehog, Group 3 and Group 4. This new sub-grouping has important therapeutic and prognostic implications. After acute leukaemia, brain tumour is the second most common malignancy in the paediatric age group. The improvement in outcome of acute lymphoblastic leukaemia in low- and middle-income countries reflects the relative simplicity of diagnostic procedures and management. Unlike leukaemia, the management of brain tumours requires a complex multidisciplinary approach, including neuro-radiologists, neurosurgeons with a paediatric expertise, neuropathologists, radiation oncologists and neuro-oncologists. In addition, the equipment required for the diagnosis (magnetic resonance imaging scan, histological, molecular and genetic techniques) and the management (operating room, radiation facilities) is a limiting factor in countries with limited resources. In Pakistan, there are very few centres able to treat children with brain tumours. The current literature review was planned to provide an update on the management of this tumour.
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Affiliation(s)
- Naureen Mushtaq
- Department of Oncology, Aga Khan University Hospital, Karachi, Pakistan
| | - Shahzadi Resham
- Department of Paediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Shahzad Shamim
- Consultant Neurosurgeon, Aga Khan University Hospital, Karachi, Pakistan
| | | | | | - Eric Bouffet
- Department of Pediatric Oncology, The Hospital of Sick Children, Toronto, Canada
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21
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Rashid A, Mushtaq N, Mansoori H. Congenital Thrombotic Thrombocytopenic Purpura With a Novel ADAMTS13 Gene Mutation. Cureus 2020; 12:e12053. [PMID: 33447482 PMCID: PMC7802116 DOI: 10.7759/cureus.12053] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Congenital thrombotic thrombocytopenic purpura (TTP) is an autosomal recessive disorder characterized by thrombocytopenia, microangiopathic hemolytic anemia (MAHA), and thrombosis. Congenital TTP should also be considered while investigating neonatal hyperbilirubinemia, hemolytic anemia, or isolated thrombocytopenia. This case is of an 8-year-old male child who presented with prolonged and recurrent history of thrombocytopenia and MAHA, first identified when he was seven weeks of age preceding neonatal hyperbilirubinemia. Peripheral blood smear examination showed thrombocytopenia and schistocytes. He then went through a series of laboratory investigations until at the age of seven years, when the ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) antigen level was performed and found to be low: 40 ng/ml (630-850). Subsequently, he received a trial of steroids and rituximab which were found to be ineffective and associated with complications. In this case, a definitive diagnosis was delayed until the age of eight years when a novel homozygous pathogenic frameshift variant ADAMTS13 c.3033delC, p.Cys1012AlafsX109 in exon 23 was identified. After receiving regular plasma infusions, thrombocytopenia and hemolysis improved. Congenital TTP should be considered in every neonatal hyperbilirubinemia, thrombocytopenia or hemolytic anemia to avoid delay in diagnosis. Early diagnosis through analysis of the ADAMTS13 gene is crucial for optimal management as well as for genetic counselling.
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Affiliation(s)
- Anila Rashid
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, PAK
| | - Naureen Mushtaq
- Department of Oncology, Aga Khan University Hospital, Karachi, PAK
| | - Huma Mansoori
- Department of Hematology, Dow University of Health Sciences, Karachi, PAK
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22
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Nobre L, Zapotocky M, Ramaswamy V, Ryall S, Bennet J, Alderete D, Guill JB, Baroni L, Bartels U, Bavle A, Bornhorst M, Boue’ DR, Canete A, Chintagumpala M, Coven SL, Cruz O, Dahiya S, Dirks P, Dunkel IJ, Eisenstat D, Conter CF, Finch E, Finlay JL, Frappaz D, Garre ML, Gauvain K, Bechensteen AG, Hansford JR, Harting I, Hauser P, Hazrati LN, Huang A, Injac SG, Iurilli V, Karajannis M, Kaur G, Kyncl M, Krskova L, Laperriere N, Larouche V, Lassaletta A, Leary S, Lin F, Mascelli S, McKeown T, Milde T, Madrid AML, Morana G, Morse H, Mushtaq N, Osorio DS, Packer R, Pavelka Z, Quiroga-Cantero E, Rutka J, Sabel M, Salgado D, Solano P, Sterba J, Su J, Sumerauer D, Taylor MD, Toledano H, Tsang DS, Fernandes MV, van Landeghem F, van Tilburg CM, Wilson B, Witt O, Zamecbik J, Bouffet E, Hawkins C, Tabori U. LGG-55. OUTCOME OF BRAF V600E PEDIATRIC GLIOMAS TREATED WITH TARGETED BRAF INHIBITION. Neuro Oncol 2020. [PMCID: PMC7715492 DOI: 10.1093/neuonc/noaa222.433] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Children with pediatric gliomas harboring BRAF V600E mutation have a poor outcome with current chemoradiation strategies. Our aim was to study the role of targeted BRAF inhibition in these tumors. We collected clinical, imaging, molecular and outcome information from BRAF V600E glioma patients treated with BRAFi across 29 centers from multiple countries. Sixty-seven patients were treated with BRAFi (56 pediatric low grade gliomas, PLGG and 11 pediatric high grade gliomas, PHGG) for up to 5.6 years. Objective responses were observed in 80% of PLGGs compared to 28% with conventional chemotherapy (p<0.001). These responses were rapid (median, 4 months), and sustained in 86% of tumors up to 5 years while on therapy. PLGG which discontinued BRAFi, 76.5% (13/17) progressed rapidly after discontinuation (median 2.3 months). However, upon re-challenge with BRAFi therapy, 90% achieved an objective response. Poor prognostic factors to conventional therapies, such as concomitant homozygous deletion of CDKN2A, were not associated with a lack of response to BRAFi. In contrast, only 36% of PHGG responded to BRAFi with all but one tumor progressing within 18 months. In PLGG, responses translated to 3-year progression-free survival of 49.6% (95%CI, 35.3% to 69.5%) vs 29.8% (95% CI, 20% to 44.4%) for BRAFi vs chemotherapy respectively (p=0.02). The use of BRAFi results in robust and durable responses while on therapy in BRAF V600E PLGG. Prospective studies are required to determine long-term survival and functional outcomes with BRAFi therapy in childhood gliomas.
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Affiliation(s)
- Liana Nobre
- The Hospital For Sick Children, Toronto, ON, Canada
| | | | | | - Scott Ryall
- The Hospital For Sick Children, Toronto, ON, Canada
| | - Julie Bennet
- The Hospital For Sick Children, Toronto, ON, Canada
| | - Daniel Alderete
- Hospital of Pediatrics S,A,M,I,C, Prof, Dr, Juan P, Garrahan, Buenos Aires, Argentina
| | | | - Lorena Baroni
- Hospital of Pediatrics S,A,M,I,C, Prof, Dr, Juan P, Garrahan, Buenos Aires, Argentina
| | - Ute Bartels
- The Hospital For Sick Children, Toronto, ON, Canada
| | | | | | | | - Adela Canete
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | | | - Ofelia Cruz
- 4Hospital Sant Joan de Déu, Barcelona, Spain
| | - Sonika Dahiya
- Washington University School of Medicine, St Louis, MO, USA
| | - Peter Dirks
- The Hospital For Sick Children, Toronto, ON, Canada
| | - Ira J Dunkel
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | | | | | | | | | | | | | - Inga Harting
- Hopp Children’s Cancer Center, Heidelberg, Germany
| | | | | | - Annie Huang
- The Hospital For Sick Children, Toronto, ON, Canada
| | | | | | | | | | - Martin Kyncl
- University Hospital Motol, Prague, Czech Republic
| | | | | | | | | | - Sarah Leary
- Seattle Children’s Hospital, Seattle, WA, USA
| | - Frank Lin
- Texas Children’s Cancer Center, Houston, TX, USA
| | | | - Tara McKeown
- The Hospital For Sick Children, Toronto, ON, Canada
| | - Till Milde
- Hopp Children’s Cancer Center, Heidelberg, Germany
| | | | | | | | | | | | - Roger Packer
- Children’s National Health System, Washington, DC, USA
| | | | | | - James Rutka
- The Hospital For Sick Children, Toronto, ON, Canada
| | | | | | - Palma Solano
- Hospital Infantil Virgen del Rocío, Sevilla, Spain
| | | | - Jack Su
- Texas Children’s Cancer Center, Houston, TX, USA
| | | | | | - Helen Toledano
- Schneiders Children’s Medical Center Of Israel, Petah Tikva, Israel
| | | | | | | | | | - Bev Wilson
- Stollery Children’s Hospital, Edmonton, AB, Canada
| | - Olaf Witt
- Hopp Children’s Cancer Center, Heidelberg, Germany
| | | | - Eric Bouffet
- The Hospital For Sick Children, Toronto, ON, Canada
| | | | - Uri Tabori
- The Hospital For Sick Children, Toronto, ON, Canada
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23
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Abstract
Intracranial germ cell tumors (GCTs) account for 3%-5% of all intracranial tumors. They commonly manifest during first two decades of life. We are reporting a case of a young female, who presented with progressive visual loss, polyuria and polydipsia, harboring an intracranial GCT. She presented initially to a neurosurgery clinic and then to an endocrine clinic, with a history of chronic worsening headache and recent onset visual blurring along with polyuria with polydipsia. On further inquiry, she was found to have primary amenorrhea, easy fatigability, and failure of development of secondary sexual characteristics. On examination the patient had bitemporal hemianopia with breast development at tanner stage II and pubic and axillary hair at tanner stage I. Her initial hormonal workup was suggestive of panhypopituitarism with diabetes insipidus. MRI pituitary showed a sellar mass with suprasellar extension, so an initial impression of a pituitary macroadenoma was made and the patient underwent trans-sphenoidal surgery. The histopathology was suggestive of lymphoid hyperplasia. Follow up MRI showed significant residual tumor and her vision and pituitary function did not recover. Neurosurgery was planned as second surgery, but we requested a second opinion of histopathology report and it was suggestive of a germinoma. She was then started on chemotherapy followed by radiotherapy, after which her tumor size reduced significantly, though she still required pituitary hormone replacement therapy. Pituitary stalk lesions are rare and their diagnosis is challenging as different etiologies present clinically and radiologically in a similar manner with tissue diagnosis being the gold standard. Germinoma is a radiosensitive tumor. In our patient it took a long time to reach the correct diagnosis and late diagnosis resulted in permanent visual field defect and panhypopituitarism. This case report emphasizes that we should guide and educate our patients to seek medical advice early in the course of disease. We should also keep differential diagnosis in mind before referring the patient for surgery.
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Affiliation(s)
- Nanik Ram
- Internal Medicine: Diabetes and Endocrinology, Aga Khan University Hospital, Karachi, PAK
| | - Sumera Batool
- Internal Medicine: Diabetes and Endocrinology, Aga Khan University Hospital, Karachi, PAK
| | - Naureen Mushtaq
- Paediatric Oncology, Aga Khan University Hospital, Karachi, PAK
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24
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Bakhshi SK, Mitha R, Mushtaq N, Shamim MS. Cerebellar Mutism Syndrome after surgical resection of posterior fossa neoplastic lesions. J PAK MED ASSOC 2020; 70:1667-1668. [PMID: 33040137] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Cerebellar Mutism Syndrome (CMS) is a well-described clinical entity that complicates surgeries for posterior fossa tumours; more so in children than adults. This review focuses on the current understanding of CMS, its incidence and risk factors. Incidence showed a variable range in retrospective studies due to variety of definitions. Risk factors can be classified as either modifiable including surgical technique, or non-modifiable which include tumour related factors. A positive correlation has been associated between tumour pathology, brain stem invasion and size of tumour at time of presentation with development of CMS.
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Affiliation(s)
| | | | - Naureen Mushtaq
- Department of Paediatrics, Aga Khan University Hospita, Karachi
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25
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Saab R, Obeid A, Gachi F, Boudiaf H, Sargsyan L, Al-Saad K, Javakhadze T, Mehrvar A, Abbas SS, Abed Al-Agele YS, Al-Haddad S, Al Ani MH, Al-Sweedan S, Al Kofide A, Jastaniah W, Khalifa N, Bechara E, Baassiri M, Noun P, El-Houdzi J, Khattab M, Sagar Sharma K, Wali Y, Mushtaq N, Batool A, Faizan M, Raza MR, Najajreh M, Mohammed Abdallah MA, Sousan G, Ghanem KM, Kocak U, Kutluk T, Demir HA, Hodeish H, Muwakkit S, Belgaumi A, Al-Rawas AH, Jeha S. Impact of the coronavirus disease 2019 (COVID-19) pandemic on pediatric oncology care in the Middle East, North Africa, and West Asia region: A report from the Pediatric Oncology East and Mediterranean (POEM) group. Cancer 2020; 126:4235-4245. [PMID: 32648950 PMCID: PMC7404449 DOI: 10.1002/cncr.33075] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/06/2020] [Accepted: 06/12/2020] [Indexed: 01/22/2023]
Abstract
Background Childhood cancer is a highly curable disease when timely diagnosis and appropriate therapy are provided. A negative impact of the coronavirus disease 2019 (COVID‐19) pandemic on access to care for children with cancer is likely but has not been evaluated. METHODS A 34‐item survey focusing on barriers to pediatric oncology management during the COVID‐19 pandemic was distributed to heads of pediatric oncology units within the Pediatric Oncology East and Mediterranean (POEM) collaborative group, from the Middle East, North Africa, and West Asia. Responses were collected on April 11 through 22, 2020. Corresponding rates of proven COVID‐19 cases and deaths were retrieved from the World Health Organization database. Results In total, 34 centers from 19 countries participated. Almost all centers applied guidelines to optimize resource utilization and safety, including delaying off‐treatment visits, rotating and reducing staff, and implementing social distancing, hand hygiene measures, and personal protective equipment use. Essential treatments, including chemotherapy, surgery, and radiation therapy, were delayed in 29% to 44% of centers, and 24% of centers restricted acceptance of new patients. Clinical care delivery was reported as negatively affected in 28% of centers. Greater than 70% of centers reported shortages in blood products, and 47% to 62% reported interruptions in surgery and radiation as well as medication shortages. However, bed availability was affected in <30% of centers, reflecting the low rates of COVID‐19 hospitalizations in the corresponding countries at the time of the survey. Conclusions Mechanisms to approach childhood cancer treatment delivery during crises need to be re‐evaluated, because treatment interruptions and delays are expected to affect patient outcomes in this otherwise largely curable disease. The response to the coronavirus disease 2019 (COVID‐19) pandemic has led to significant alterations in access to care for children with cancer. Interventions are needed to mitigate the effects on life‐threatening diseases requiring immediate and uninterrupted therapy, such as childhood cancer.
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Affiliation(s)
- Raya Saab
- Children's Cancer Institute, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Anas Obeid
- Children's Cancer Institute, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fatiha Gachi
- Department of Pediatrics, Pierre and Marie Curie Center, Algiers, Algeria
| | - Houda Boudiaf
- Department of Pediatrics, Mustapha Pacha Hospital, Moustapha, Algeria
| | - Lilit Sargsyan
- Pediatric Cancer and Blood Disorders Center of Armenia, Professor R.H. Yeolyan Hematology Center, Yerevan, Armenia
| | - Khulood Al-Saad
- Department of Pediatrics, Salmaniya Medical Complex, Manama, Bahrain
| | - Tamar Javakhadze
- Department of Pediatrics, Iashvili Children's Central Hospital, Tbilisi, Georgia
| | - Azim Mehrvar
- MAHAK Pediatric Cancer Treatment and Research Center, Tehran, Iran
| | - Sawsan Sati Abbas
- Department of Pediatrics, Al-Imamian Al-Kadhimiyain Medical City, Baghdad, Iraq
| | | | - Salma Al-Haddad
- Department of Pediatrics, Children Welfare Teaching Hospital, Medical City, Baghdad, Iraq
| | | | - Suleiman Al-Sweedan
- Department of Pediatrics, King Abdullah University Hospital, Ar Ramtha, Jordan
| | - Amani Al Kofide
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Wasil Jastaniah
- Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs-Western Region, Jeddah, Kingdom of Saudi Arabia.,College of Medicine, Umm AlQura University, Makkah, Kingdom of Saudi Arabia
| | - Nisreen Khalifa
- National Bank of Kuwait Children's Hospital, Kuwait City, Kuwait
| | - Elie Bechara
- Department of Pediatrics, Lebanese Hospital Geitaoui, Beirut, Lebanon
| | - Malek Baassiri
- Department of Pediatrics, Makassed General Hospital, Beirut, Lebanon.,Department of Pediatrics, Hammoud Hospital University Medical Center, Saida, Lebanon
| | - Peter Noun
- Department of Pediatrics, St George Hospital University Medical Center, Beirut, Lebanon
| | - Jamila El-Houdzi
- Department of Pediatric Hematology-Oncology, Mohammed VI Marrakech University Hospital Center, Marrakech, Morocco
| | - Mohammed Khattab
- Pediatric Hematology and Oncology Center, Ibn Sina University Hospital Center, Rabat, Morocco
| | - Krishna Sagar Sharma
- Department of Medical Oncology, B.P. Koirala Memorial Cancer Hospital, Bharatpur, Nepal
| | - Yasser Wali
- Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman
| | - Naureen Mushtaq
- Department of Pediatrics, Aga Khan University Hospital, Karachi, Pakistan
| | - Aliya Batool
- Pediatric Hematology Oncology and Bone Marrow Transplant Unit, Dr. Akbar Niazi Teaching Hospital, Islamabad, Pakistan
| | - Mahwish Faizan
- Department of Pediatric Hematology, Oncology and Bone Marrow Transplant, The Children's Hospital and the Institute of Child Health, Lahore, Pakistan
| | | | - Mohammad Najajreh
- Huda Al Masri Pediatric Cancer Department, Beit Jala Governmental Hospital, Beit Jala, Palestine
| | | | - Ghada Sousan
- Department of Pediatrics, Al Bairouni Hospital, Damascus, Syria
| | - Khaled M Ghanem
- Basma Pediatric Oncology Unit, Al Bairouni Hospital, Damascus, Syria
| | - Ulker Kocak
- Department of Pediatrics, Gazi University Hospital, Ankara, Turkey
| | - Tezer Kutluk
- Department of Pediatric Oncology, Hacettepe University Cancer Institute and Faculty of Medicine, Ankara, Turkey
| | - Hacı Ahmet Demir
- Department of Pediatric Hematology-Oncology, Private Memorial Ankara Hospital, Ankara, Turkey
| | - Hamoud Hodeish
- Pediatric Oncology Department, National Oncology Center, Sana'a, Yemen
| | - Samar Muwakkit
- Children's Cancer Institute, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Asim Belgaumi
- Department of Pediatrics, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Sima Jeha
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee
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P, Tam J, Elias J, Ngaage M, Thompson J, Bristow S, Brock E, Davis H, Pantelidou M, Sathiyakeerthy A, Singh K, Chaudhry A, Dickson G, Glen P, Gregoriou K, Hamid H, Mclean A, Mehtaji P, Neophytou G, Potts S, Belgaid DR, Burke J, Durno J, Ghailan N, Hanson M, Henshaw V, Nazir UR, Omar I, Riley BJ, Roberts J, Smart G, Van Winsen K, Bhatti A, Chan M, D'Auria M, Green S, Keshvala C, Li H, Maxwell-Armstrong C, Michaelidou M, Simmonds L, Smith C, Wimalathasan A, Abbas J, Cairns C, Chin YR, Connelly A, Moug S, Nair A, Svolkinas D, Coe P, Subar D, Wang H, Zaver V, Brayley J, Cookson P, Cunningham L, Gaukroger A, Ho M, Hough A, King J, O'Hagan D, Widdison A, Brown R, Brown B, Chavan A, Francis S, Hare L, Lund J, Malone N, Mavi B, McIlwaine A, Rangarajan S, Abuhussein N, Campbell HS, Daniels J, Fitzgerald I, Mansfield S, Pendrill A, Robertson D, Smart YW, Teng T, Yates J, Belgaumkar A, Katira A, Kossoff J, Kukran S, Laing C, Mathew B, Mohamed T, Myers S, Novell R, Phillips BL, Thomas M, Turlejski 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Cummings D, Kershaw S, Ong J, Reid F, Toellner H, Alwandi A, Amer M, George D, Haynes K, Hughes K, Peakall L, Premakumar Y, Punjabi N, Ramwell A, Sawkins H, Ashwood J, Baker A, Baron C, Bhide I, Blake E, De Cates C, Esmail R, Hosamuddin H, Kapp J, Nguru N, Raja M, Thomson F, Ahmed H, Aishwarya G, Al-Huneidi R, Ali S, Aziz R, Burke D, Clarke B, Kausar A, Maskill D, Mecia L, Myers L, Smith ACD, Walker G, Wroe N, Donohoe C, Gibbons D, Jordan P, Keogh C, Kiely A, Lalor P, McCrohan M, Powell C, Foley MP, Reynolds J, Silke E, Thorpe O, Kong JTH, White C, Ali Q, Dalrymple J, Ge Y, Khan H, Luo RS, Paine H, Paraskeva B, Parker L, Pillai K, Salciccioli J, Selvadurai S, Sonagara V, Springford LR, Tan L, Appleton S, Leadholm N, Zhang Y, Ahern D, Cotter M, Cremen S, Durrigan T, Flack V, Hrvacic N, Jones H, Jong B, Keane K, O'Connell PR, O'sullivan J, Pek G, Shirazi S, Barker C, Brown A, Carr W, Chen Y, Guillotte C, Harte J, Kokayi A, Lau K, McFarlane S, Morrison S, Broad J, Kenefick N, Makanji D, 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Livesey C, McLachlan G, Mohammad M, Pranesh N, Richards C, Ross F, Sajid M, Brooke M, Francombe J, Gresly J, Hutchinson S, Kerrigan K, Matthews E, Nur S, Parsons L, Sandhu A, Vyas M, White F, Zulkifli A, Zuzarte L, Al-Mousawi A, Arya J, Azam S, Yahaya AA, Gill K, Hallan R, Hathaway C, Leptidis I, McDonagh L, Mitrasinovic S, Mushtaq N, Pang N, Peiris GB, Rinkoff S, Chan L, Christopher E, Farhan-Alanie MMH, Gonzalez-Ciscar A, Graham CJ, Lim H, McLean KA, Paterson HM, Rogers A, Roy C, Rutherford D, Smith F, Zubikarai G, Al-Khudairi R, Bamford M, Chang M, Cheng J, Hedley C, Joseph R, Mitchell B, Perera S, Rothwell L, Siddiqui A, Smith J, Taylor K, Wright OW, Baryan HK, Boyd G, Conchie H, Cox L, Davies J, Gardner S, Hill N, Krishna K, Lakin F, Scotcher S, Alberts J, Asad M, Barraclough J, Campbell A, Marshall D, Wakeford W, Cronbach P, D'Souza F, Gammeri E, Houlton J, Hall M, Kethees A, Patel R, Perera M, Prowle J, Shaid M, Webb E, Beattie S, Chadwick M, El-Taji O, Haddad S, Mann M, Patel M, Popat K, Rimmer L, Riyat H, Smith H, Anandarajah C, Cipparrone M, Desai K, Gao C, Goh ET, Howlader M, Jeffreys N, Karmarkar A, Mathew G, Mukhtar H, Ozcan E, Renukanthan A, Sarens N, Sinha C, Woolley A, Bogle R, Komolafe O, Loo F, Waugh D, Zeng R, Crewe A, Mathias J, Mills A, Owen A, Prior A, Saunders I, Baker A, Crilly L, McKeon J, Ubhi HK, Adeogun A, Carr R, Davison C, Devalia S, Hayat A, Karsan RB, Osborne C, Scott K, Weegenaar C, Wijeyaratne M, Babatunde F, Barnor-Ahiaku E, Beattie G, Chitsabesan P, Dixon O, Hall N, Ilenkovan N, Mackrell T, Nithianandasivam N, Orr J, Palazzo F, Saad M, Sandland-Taylor L, Sherlock J, Ashdown T, Chandler S, Garsaa T, Lloyd J, Loh SY, Ng S, Perkins C, Powell-Chandler A, Smith F, Underhill R. Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study. Br J Surg 2020; 107:1023-1032. [PMID: 32026470 DOI: 10.1002/bjs.11453] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/21/2019] [Accepted: 11/08/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. METHODS This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery. RESULTS A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498). CONCLUSION There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.
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Nobre L, Zapotocky M, Ramaswamy V, Ryall S, Bennett J, Alderete D, Balaguer Guill J, Baroni L, Bartels U, Bavle A, Bornhorst M, Boue DR, Canete A, Chintagumpala M, Coven SL, Cruz O, Dahiya S, Dirks P, Dunkel IJ, Eisenstat D, Faure Conter C, Finch E, Finlay JL, Frappaz D, Garre ML, Gauvain K, Bechensteen AG, Hansford JR, Harting I, Hauser P, Hazrati LN, Huang A, Injac SG, Iurilli V, Karajannis M, Kaur G, Kyncl M, Krskova L, Laperriere N, Larouche V, Lassaletta A, Leary S, Lin F, Mascelli S, McKeown T, Milde T, Morales La Madrid A, Morana G, Morse H, Mushtaq N, Osorio DS, Packer R, Pavelka Z, Quiroga-Cantero E, Rutka J, Sabel M, Salgado D, Solano P, Sterba J, Su J, Sumerauer D, Taylor MD, Toledano H, Tsang DS, Valente Fernandes M, van Landeghem F, van Tilburg CM, Wilson B, Witt O, Zamecnik J, Bouffet E, Hawkins C, Tabori U. Outcomes of BRAF V600E Pediatric Gliomas Treated With Targeted BRAF Inhibition. JCO Precis Oncol 2020; 4:1900298. [PMID: 32923898 DOI: 10.1200/po.19.00298] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Children with pediatric gliomas harboring a BRAF V600E mutation have poor outcomes with current chemoradiotherapy strategies. Our aim was to study the role of targeted BRAF inhibition in these tumors. PATIENTS AND METHODS We collected clinical, imaging, molecular, and outcome information from patients with BRAF V600E-mutated glioma treated with BRAF inhibition across 29 centers from multiple countries. RESULTS Sixty-seven patients were treated with BRAF inhibition (pediatric low-grade gliomas [PLGGs], n = 56; pediatric high-grade gliomas [PHGGs], n = 11) for up to 5.6 years. Objective responses were observed in 80% of PLGGs, compared with 28% observed with conventional chemotherapy (P < .001). These responses were rapid (median, 4 months) and sustained in 86% of tumors up to 5 years while receiving therapy. After discontinuation of BRAF inhibition, 76.5% (13 of 17) of patients with PLGG experienced rapid progression (median, 2.3 months). However, upon rechallenge with BRAF inhibition, 90% achieved an objective response. Poor prognostic factors in conventional therapies, such as concomitant homozygous deletion of CDKN2A, were not associated with lack of response to BRAF inhibition. In contrast, only 36% of those with PHGG responded to BRAF inhibition, with all but one tumor progressing within 18 months. In PLGG, responses translated to 3-year progression-free survival of 49.6% (95% CI, 35.3% to 69.5%) versus 29.8% (95% CI, 20% to 44.4%) for BRAF inhibition versus chemotherapy, respectively (P = .02). CONCLUSION Use of BRAF inhibition results in robust and durable responses in BRAF V600E-mutated PLGG. Prospective studies are required to determine long-term survival and functional outcomes with BRAF inhibitor therapy in childhood gliomas.
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Affiliation(s)
- Liana Nobre
- Department of Hematology and Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | - Michal Zapotocky
- Department of Hematology and Oncology, Hospital for Sick Children, Toronto, ON, Canada.,Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Vijay Ramaswamy
- Department of Hematology and Oncology, Hospital for Sick Children, Toronto, ON, Canada.,Developmental and Stem Cell Biology Program, Hospital for Sick Children, Toronto, ON, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Scott Ryall
- Department of Hematology and Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | - Julie Bennett
- Department of Hematology and Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | - Daniel Alderete
- Hospital of Pediatrics SAMIC Prof. Dr Juan P. Garrahan, Buenos Aires, Argentina
| | - Julia Balaguer Guill
- Hospital Universitario y Politecnico La Fe, University of Valencia, Valencia, Spain
| | - Lorena Baroni
- Hospital of Pediatrics SAMIC Prof. Dr Juan P. Garrahan, Buenos Aires, Argentina
| | - Ute Bartels
- Department of Hematology and Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | - Abhishek Bavle
- Jimmy Everest Section of Pediatric Heamatology/Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | | | - Daniel R Boue
- Nationwide Children's Hospital and Ohio State University, Columbus, OH
| | - Adela Canete
- Hospital Universitario y Politecnico La Fe, University of Valencia, Valencia, Spain
| | | | - Scott L Coven
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Indiana University, Indianapolis, IN
| | | | - Sonika Dahiya
- Washington University School of Medicine, St Louis, MO
| | - Peter Dirks
- Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada.,Division of Neurosurgery, Hospital for Sick Children, Toronto, ON, Canada
| | - Ira J Dunkel
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - David Eisenstat
- Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | | | - Elizabeth Finch
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jonathan L Finlay
- Nationwide Children's Hospital and Ohio State University, Columbus, OH
| | - Didier Frappaz
- Institute d'Hémato-Oncologie Pédiatrique, Centre Leon Berard, Lyon, France
| | | | - Karen Gauvain
- Washington University School of Medicine, St Louis, MO
| | | | - Jordan R Hansford
- Royal Children's Hospital, Murdoch Children's Research Institute, University of Melbourne, Melbourne, VIC, Australia
| | - Inga Harting
- Hopp Children's Cancer Center Heidelberg, Heidelberg, Germany
| | | | - Lili-Naz Hazrati
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Annie Huang
- Department of Hematology and Oncology, Hospital for Sick Children, Toronto, ON, Canada.,Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada
| | | | | | | | | | - Martin Kyncl
- Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Lenka Krskova
- Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Normand Laperriere
- Department of Hematology and Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | | | | | | | - Frank Lin
- Texas Children's Cancer Center, Houston, TX
| | | | - Tara McKeown
- Department of Hematology and Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | - Till Milde
- Hopp Children's Cancer Center Heidelberg, Heidelberg, Germany
| | | | | | | | | | - Diana S Osorio
- Nationwide Children's Hospital and Ohio State University, Columbus, OH
| | - Roger Packer
- Children's National Health System, Washington, DC
| | - Zdenek Pavelka
- University Hospital Brno, Masaryk University, and ICRC Brno, Brno, Czech Republic
| | | | - James Rutka
- Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada.,Division of Neurosurgery, Hospital for Sick Children, Toronto, ON, Canada
| | - Magnus Sabel
- Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | | | - Palma Solano
- Hospital Infantil Virgen del Rocío, Sevilla, Spain
| | - Jaroslav Sterba
- University Hospital Brno, Masaryk University, and ICRC Brno, Brno, Czech Republic
| | - Jack Su
- Texas Children's Cancer Center, Houston, TX
| | - David Sumerauer
- Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Michael D Taylor
- Developmental and Stem Cell Biology Program, Hospital for Sick Children, Toronto, ON, Canada.,Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada.,Division of Neurosurgery, Hospital for Sick Children, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Department of Surgery, University of Ontario, Toronto, ON, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Helen Toledano
- Schneiders Children's Medical Center of Israel, Petah Tikva, Israel
| | - Derek S Tsang
- Department of Hematology and Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | | | | | | | - Bev Wilson
- Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | - Olaf Witt
- Hopp Children's Cancer Center Heidelberg, Heidelberg, Germany
| | - Josef Zamecnik
- Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Eric Bouffet
- Department of Hematology and Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | - Cynthia Hawkins
- Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Department of Pediatric Laboratory Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Uri Tabori
- Department of Hematology and Oncology, Hospital for Sick Children, Toronto, ON, Canada.,Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada
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Mustansir F, Mushtaq N, Darbar A. Dabrafenib in BRAFV600E mutant pilocytic astrocytoma in a pediatric patient. Childs Nerv Syst 2020; 36:203-207. [PMID: 31418082 DOI: 10.1007/s00381-019-04346-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 06/06/2019] [Accepted: 08/07/2019] [Indexed: 11/29/2022]
Abstract
Pilocytic astrocytomas (PAs) are the most common pediatric central nervous system tumors. They constitute around 30% of all primary central nervous tumors in the pediatric age group. Their clinical behavior may vary but most of them are indolent and do not undergo malignant transformations compared with their adult counterparts. PAs are primarily treated with surgery and in cases of progression; chemotherapy may be needed. They usually carry a good prognosis, with a 10-year survival rate of 90%. BRAFV600E mutations have been identified in approximately 9-15% of patients with PA. These relatively high mutation frequencies in PA open avenues for treatment using targeted therapies such as BRAFV600E inhibitors (e.g., dabrafenib). There have been a few published case reports and case series showing clinical benefits with BRAF inhibitors in BRAF-positive tumors. We report a case of successful treatment of BRAFV600E immunopositive optic pathway PA in a child with dabrafenib.
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Affiliation(s)
- F Mustansir
- Department of Surgery, The Aga Khan University, Karachi, Sindh, Pakistan.
| | - N Mushtaq
- Department of Pediatrics, The Aga Khan University, Karachi, Sindh, Pakistan
| | - A Darbar
- Department of Surgery, The Aga Khan University, Karachi, Sindh, Pakistan
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Riaz Q, Naeem E, Fadoo Z, Lohano M, Mushtaq N. Intracranial tumors in children: a 10-year review from a single tertiary health-care center. Childs Nerv Syst 2019; 35:2347-2353. [PMID: 31267185 DOI: 10.1007/s00381-019-04260-7] [Citation(s) in RCA: 10] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 06/10/2019] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Brain tumors are the second most common pediatric malignancy and the most common cause of cancer-related mortality and morbidities. Major advances in terms of surgery, radiation, and chemotherapy have led to better outcomes in developed countries. Delayed diagnosis, advanced disease at presentation, late referrals, nosocomial infections, delays to radiotherapy, and poor support services are the major reasons for poorer outcomes in developing countries. Little is known about the profile of brain tumors in Pakistan. This study aims to evaluate the epidemiology, management, and clinical outcomes of children with brain tumors in Pakistan in a single tertiary care center. METHODS/MATERIALS All children (0-16 years) with primary CNS tumors from 2004 to 2014 at Aga Khan University Hospital were reviewed retrospectively for clinical data, demographics, radiological findings, management, and outcome. RESULTS One hundred seventy-five children were included in the study. Male to female ratio was 1.4:1. Most of the patients were in 5-10 years age group (38.9%). Most common presenting complains were headache 115 (65.7%) and vomiting 100 (57.1%). Predominant site was infratentorial 93 (53%). Glial tumors were 105 (60%) followed by embryonal 40(22.9%), craniopharyngiomas 25 (14.3%), and germ cell 1 (0.6%). Astrocytomas (25.7%) were the most common glial tumors while medulloblastoma (15.4%) was the most common embryonal tumor. Majority of the patients underwent surgical resection (78.8%). Radiation was given to 47 (26.8%) patients. A half of the patients, 89 (50%), were lost to follow-up. Forty-two (24%) patients expired, 20 (11.4%) are alive with residual disease while 15 patients (8.5%) were cured with no evidence of recurrence and regular follow-ups. CONCLUSION This is the only study from Pakistan showing demographics of the childhood brain tumors. Significant improvement needs to be made for timely diagnosis, early referrals, and collaborated team efforts with multidisciplinary tumor board to improve outcome.
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Affiliation(s)
- Quratulain Riaz
- Department of Oncology, Aga Khan University, Karachi, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan.
| | - Ehsun Naeem
- Department of Medicine, Aga Khan University, Karachi, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan
| | - Zehra Fadoo
- Department of Oncology, Aga Khan University, Karachi, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan
| | - Mahadev Lohano
- Specialist Pediatric Haematology/Oncology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Naureen Mushtaq
- Department of Oncology, Aga Khan University, Karachi, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan
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Abstract
Objective: The aim of this study was to analyze the clinical profiles and outcomes of pediatric brainstem gliomas treated at our institute. Methodology: We reviewed the files of 18 pediatric age group patients diagnosed with brainstem glioma at our institution. The following variables were recorded: age, sex, duration of symptoms, date of diagnosis, main clinical symptoms, Karnofsky performance status score, magnetic resonance imaging findings, histopathology findings, details of the treatment given, disease progression, and date of mortality/last follow-up. This data were then transferred to SPSS version 23 which was used for further analysis. Results: The mean age of our cohort was 8.6 years (range 3–15). There were 11 (61.1%) males and 7 (38.9%) females. There were 16 (88.9%) patients with diffuse intrinsic pontine gliomas (DIPGs), 1 (5.6%) patients with exophytic medullary gliomas, and 1 (5.6%) patient with midbrain/tectal glioma. Mean overall survival (OS) was 9.7 months. Mean progression-free survival (PFS) was 6.3 months. All patients with DIPG eventually passed away from their disease. Patients with DIPG who received radiotherapy had a longer OS and PFS than those who did not (9.8 and 6 months vs. 3.4 and 2.4 months). Diagnostic latency >1 month was found to have a statistically significant longer progression-free interval. Conclusion: DIPGs in the pediatric population have a poor prognosis. Radiotherapy serves to increase survival time but is not curative.
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Affiliation(s)
- Altaf Ali Laghari
- Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Mirza Zain Baig
- Rudy L. Ruggles Biomedical Research Institute, Danbury, Connecticut, USA
| | - Ehsan Bari
- Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Aneela Darbar
- Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Naureen Mushtaq
- Department of Pediatrics, Aga Khan University Hospital, Karachi, Pakistan
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Nobre L, Zapotocky M, Ramaswamy V, Ryall S, Bennett J, Balaguer Guill J, Baroni L, Bartels U, Bornhorst M, Boue` D, Chintagumpala M, Cruz O, Dahiya S, Dirks P, Dunkel I, Eisenstat D, Finch E, Finlay J, Frappaz D, Luisa Garre M, Gauvain K, Grete Bechensteen A, Hansford J, Hauser P, Huang A, Karajannis M, Kaur G, Larouche V, Lassaletta A, Leary S, Lin F, McKeown T, Milde T, Morales La Madrid A, Morse H, Mushtaq N, Osorio D, Packer R, Pavelka Z, Salgado D, Sabel M, Solano P, Su J, Sumerauer D, Toledano H, van Tilburg C, Wilson B, Bouffet E, Hawkins C, Tabori U. PDCT-08. SUPERIOR OUTCOME FOR BRAF V600E PEDIATRIC GLIOMAS TREATED WITH TARGETED BRAF INHIBITION. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.771] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Children with pediatric low grade glioma’s (PLGG) harboring BRAF V600E mutation have poor outcome due to relative resistance to chemo-radiation and higher risk of malignant transformation. However, the role of targeted BRAF inhibition in these tumors is poorly defined.
METHODS
We assembled an international cohort of children with BRAF V600E mutant gliomas treated with BRAF inhibition, from 29 centers participating in the PLGG taskforce, and collected response, survival and molecular parameters.
RESULTS
Sixty-seven patients were treated with BRAFi (56 PLGG and 11 high grade gliomas) for a median time of 17.4 months (6 – 61 months), with 13 PLGG treated upfront. Objective responses was observed in 80% of PLGG patients compared to 28% with conventional chemotherapy (p< 0.001). Rapid responses were observed in most PLGG patients (median of 4 months), sustained in 86% of tumors up to 5 years while on therapy. In contrast, only 36% of PHGG responded to BRAFi with all but one tumor progressing within 18 months. Seventeen patients with PLGG discontinued BRAFi and 76.5% (13/17) progressed rapidly after discontinuation (median time 2.3 months). However, upon re-challenge with BRAFi therapy, 90% achieved an objective response. Poor prognostic factors to conventional therapies such as concomitant homozygous deletion of CDKN2A or H3K27M mutation were not associated with lack of response to BRAFi. Overall these responses translated to 2-year progression-free survival of 0.636 (95%CI 0.505–0.802) and 0.43 (95% CI 0.32–0.57) for BRAFi and chemotherapy treated BRAF V600E PLGG respectively (p=0.003).
CONCLUSION
The use of BRAFi results in objective, robust and durable responses in BRAF V600E PLGG and is associated with favorable survival. Larger prospective studies will be required to determine appropriate regiments, and long-term functional outcomes with BRAFi therapy in childhood gliomas.
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Affiliation(s)
| | - Michal Zapotocky
- Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | | | | | | | | | - Lorena Baroni
- Hospital of Pediatrics S.A.M.I.C. Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | | | | | - Daniel Boue`
- Nationwide Children’s Hospital and the Ohio State University, Columbus, OH, USA
| | | | | | - Sonika Dahiya
- Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Peter Dirks
- Developmental and Stem Cell Biology Program and Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Ira Dunkel
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Jonathan Finlay
- Nationwide Children’s Hospital & The Ohio State University, Columbus, OH, USA
| | | | | | - Karen Gauvain
- Washington University School of Medicine, St. Louis, MO, USA
| | | | - Jordan Hansford
- Children’s Cancer Centre, Royal Children’s Hospital, Melbourne, Australia
| | | | - Annie Huang
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | | | | | | | - Sarah Leary
- Seattle Children’s Hospital, Seattle, WA, USA
| | - Frank Lin
- Texas Children’s Cancer Center, Houston, TX, USA
| | | | - Til Milde
- Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
| | | | | | | | | | - Roger Packer
- Children’s National Health System, Washington, DC, USA
| | | | | | - Magnus Sabel
- Queen Silvia Children’s Hospital, Göteborg, Sweden
| | - Palma Solano
- Hospital Infantil Virgen del Rocío, Sevilla, Spain
| | - Jack Su
- Texas Children’s Cancer Center, Houston, TX, USA
| | | | - Helen Toledano
- Department of Pediatric Hematology Oncology, Children’s Medical Center of Israel, Petach Tikva, Israel
| | | | - Bev Wilson
- University of Alberta, Edmonton, AB, Canada
| | - Eric Bouffet
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Uri Tabori
- University of Toronto, Toronto, ON, Canada
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Butt A, Jeeva I, Masud S, Fadoo Z, Altaf S, Mushtaq N. Orbital tumor board: life saver or time waster? Leuk Res 2019. [DOI: 10.1016/s0145-2126(19)30393-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Shuen AY, Lanni S, Panigrahi GB, Edwards M, Yu L, Campbell BB, Mandel A, Zhang C, Zhukova N, Alharbi M, Bernstein M, Bowers DC, Carroll S, Cole KA, Constantini S, Crooks B, Dvir R, Farah R, Hijiya N, George B, Laetsch TW, Larouche V, Lindhorst S, Luiten RC, Magimairajan V, Mason G, Mason W, Mordechai O, Mushtaq N, Nicholas G, Oren M, Palma L, Pedroza LA, Ramdas J, Samuel D, Wolfe Schneider K, Seeley A, Semotiuk K, Shamvil A, Sumerauer D, Toledano H, Tomboc P, Wierman M, Van Damme A, Lee YY, Zapotocky M, Bouffet E, Durno C, Aronson M, Gallinger S, Foulkes WD, Malkin D, Tabori U, Pearson CE. Functional Repair Assay for the Diagnosis of Constitutional Mismatch Repair Deficiency From Non-Neoplastic Tissue. J Clin Oncol 2019; 37:461-470. [PMID: 30608896 DOI: 10.1200/jco.18.00474] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Constitutional mismatch repair deficiency (CMMRD) is a highly penetrant cancer predisposition syndrome caused by biallelic mutations in mismatch repair (MMR) genes. As several cancer syndromes are clinically similar, accurate diagnosis is critical to cancer screening and treatment. As genetic diagnosis is confounded by 15 or more pseudogenes and variants of uncertain significance, a robust diagnostic assay is urgently needed. We sought to determine whether an assay that directly measures MMR activity could accurately diagnose CMMRD. PATIENTS AND METHODS In vitro MMR activity was quantified using a 3'-nicked G-T mismatched DNA substrate, which requires MSH2-MSH6 and MLH1-PMS2 for repair. We quantified MMR activity from 20 Epstein-Barr virus-transformed lymphoblastoid cell lines from patients with confirmed CMMRD. We also tested 20 lymphoblastoid cell lines from patients who were suspected for CMMRD. We also characterized MMR activity from patients with neurofibromatosis type 1, Li-Fraumeni syndrome, polymerase proofreading-associated cancer syndrome, and Lynch syndrome. RESULTS All CMMRD cell lines had low MMR activity (n = 20; mean, 4.14 ± 1.56%) relative to controls (n = 6; mean, 44.00 ± 8.65%; P < .001). Repair was restored by complementation with the missing protein, which confirmed MMR deficiency. All cases of patients with suspected CMMRD were accurately diagnosed. Individuals with Lynch syndrome (n = 28), neurofibromatosis type 1 (n = 5), Li-Fraumeni syndrome (n = 5), and polymerase proofreading-associated cancer syndrome (n = 3) had MMR activity that was comparable to controls. To accelerate testing, we measured MMR activity directly from fresh lymphocytes, which yielded results in 8 days. CONCLUSION On the basis of the current data set, the in vitro G-T repair assay was able to diagnose CMMRD with 100% specificity and sensitivity. Rapid diagnosis before surgery in non-neoplastic tissues could speed proper therapeutic management.
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Affiliation(s)
- Andrew Y Shuen
- 1 University of Toronto, Toronto, Ontario, Canada.,2 The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stella Lanni
- 2 The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | - Lisa Yu
- 2 The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Brittany B Campbell
- 1 University of Toronto, Toronto, Ontario, Canada.,2 The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ariane Mandel
- 2 The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cindy Zhang
- 2 The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nataliya Zhukova
- 1 University of Toronto, Toronto, Ontario, Canada.,2 The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Mark Bernstein
- 4 Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Daniel C Bowers
- 5 University of Texas Southwestern Medical Center, Dallas, TX.,6 Children's Health, Dallas, TX
| | | | - Kristina A Cole
- 8 Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA
| | - Shlomi Constantini
- 9 Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,10 Tel Aviv University, Tel Aviv, Israel
| | - Bruce Crooks
- 4 Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Rina Dvir
- 10 Tel Aviv University, Tel Aviv, Israel.,11 Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Roula Farah
- 12 Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Nobuko Hijiya
- 13 Ann & Robert H. Lurie Children's Hospital/Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ben George
- 14 Medical College of Wisconsin, Milwaukee, WI
| | - Theodore W Laetsch
- 5 University of Texas Southwestern Medical Center, Dallas, TX.,6 Children's Health, Dallas, TX
| | | | | | | | | | - Gary Mason
- 19 Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Warren Mason
- 1 University of Toronto, Toronto, Ontario, Canada.,20 Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | | | - Garth Nicholas
- 23 Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Laura Palma
- 25 McGill University Health Centre, Montréal, Quebec, Canada
| | - Luis Alberto Pedroza
- 26 Baylor College of Medicine and Texas Children's Hospital, Houston, TX.,27 Universidad San Francisco de Quito, Quito, Ecuador
| | | | | | - Kami Wolfe Schneider
- 30 Children's Hospital Colorado, Aurora, CO.,31 University of Colorado, Anschutz Medical Campus, Aurora, CO
| | | | | | | | - David Sumerauer
- 34 University Hospital Motol, Charles University, Prague, Czech Republic
| | - Helen Toledano
- 11 Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | | | | | - An Van Damme
- 36 Université Catholique de Louvain, Brussels, Belgium
| | - Yi-Yen Lee
- 37 Taipei Veterans General Hospital, Taipei, Republic of China
| | - Michal Zapotocky
- 1 University of Toronto, Toronto, Ontario, Canada.,2 The Hospital for Sick Children, Toronto, Ontario, Canada.,34 University Hospital Motol, Charles University, Prague, Czech Republic
| | - Eric Bouffet
- 1 University of Toronto, Toronto, Ontario, Canada.,2 The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Carol Durno
- 2 The Hospital for Sick Children, Toronto, Ontario, Canada.,32 Mount Sinai Hospital, Toronto, Ontario, Canada
| | | | - Steve Gallinger
- 32 Mount Sinai Hospital, Toronto, Ontario, Canada.,38 Toronto General Hospital, Toronto, Ontario, Canada
| | | | - David Malkin
- 1 University of Toronto, Toronto, Ontario, Canada.,2 The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Uri Tabori
- 1 University of Toronto, Toronto, Ontario, Canada.,2 The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Christopher E Pearson
- 1 University of Toronto, Toronto, Ontario, Canada.,2 The Hospital for Sick Children, Toronto, Ontario, Canada
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Badar N, Salman M, Ansari J, Bashir U, Mushtaq N, Ahmad H, Ikram A. Chikungunya virus: A major threat to human population and its molecular epidemiology in pakistan. Int J Infect Dis 2018. [DOI: 10.1016/j.ijid.2018.04.3847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Mansha MA, Khan AMH, Abbasi ANN, Tariq MUU, Mushtaq N, Tariq M, Waheed A. Glioblastoma Multiforme Involving Conus Medullaris in a Child. Cureus 2018; 10:e2863. [PMID: 30148015 PMCID: PMC6107034 DOI: 10.7759/cureus.2863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 06/22/2018] [Indexed: 11/05/2022] Open
Abstract
Primary spinal cord glioblastoma multiforme involving the conus medullaris is an uncommon entity with poor outcomes. An aggressive multimodality treatment approach has been used, but prognosis remains same. There are no guidelines for the treatment of patients with spinal glioblastoma multiforme (GBM). We highlight the case of a child diagnosed with conal GBM. He was treated with definitive surgery followed by adjuvant concurrent chemoradiation. After completion of treatment, he showed a temporary symptomatic improvement, but later on his condition deteriorated. We elaborate the stepwise treatment approach employed in this patient.
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Affiliation(s)
| | | | | | | | | | - Maria Tariq
- Pediatrics, Aga Khan University, Karachi, PAK
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Mushtaq N, Riaz Q, Hawkins C, Ramaswamy V, Minhas K, Bouffet E. MBRS-10. RISK STRATIFICATION OF MEDULLOBLASTOMA ON THE BASIS OF MOLECULAR SUBGROUPING; AN EXPERIENCE FROM A SINGLE TERTIARY CARE CENTER FROM A DEVELOPING COUNTRY. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | | | | | - Eric Bouffet
- The Hospital Of Sick Children, Toronto, ON, Canada
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Hessissen L, Parkes J, Amayiri N, Mushtaq N, Sirachainan N, Anacak Y, Mitra D, Figaji A, Schouten-van Meeteren A, Sullivan M, Burger H, Davidson A, Bouffet E, Bailey S. SIOP PODC Adapted treatment guidelines for low grade gliomas in low and middle income settings. Pediatr Blood Cancer 2017; 64 Suppl 5. [PMID: 29297618 DOI: 10.1002/pbc.26737] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 11/03/2016] [Accepted: 06/22/2017] [Indexed: 12/15/2022]
Abstract
Effective treatment of children with low grade glioma (LGG) requires a functioning multi-disciplinary team with adequate neurosurgical, neuroradiological, pathological, radiotherapy and chemotherapy facilities and personnel. In addition, the treating centre should have the capacity to manage a variety of LGG and treatment-associated complications. These requirements have made it difficult for many centers in low and middle-income countries (LMIC) to offer effective treatment and follow up. This article provides management recommendations for children with LGG according to the level of facilities available.
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Affiliation(s)
- Laila Hessissen
- Department of Hematology and Pediatric Oncology, Hospital University Ibn Sina, Rabat, Morocco
| | - Jeannette Parkes
- Department of Radiation Oncology, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Nisreen Amayiri
- Department of Hematology and Oncology, King Hussein Cancer Centre, Amman, Jordan
| | - Naureen Mushtaq
- Department of Pediatric Haematology and Oncology, Aga Khan University Hopsital, Karachi, Pakistan
| | - Nongnuch Sirachainan
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Yavuz Anacak
- Department of Radiation Oncology, Ege University School of Medicine & Hospital, Izmir, Turkey
| | - Dipayan Mitra
- Department of Radiology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Anthony Figaji
- Department of Neurosurgery, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa
| | | | - Michael Sullivan
- Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, Melbourne, Victoria, Australia
| | - Hester Burger
- Department Medical Physics, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Alan Davidson
- Haematology Oncology Service, Red Cross War Memorial Children's Hospital, Department of Paediatrics and Child Health, University of Cape Town, South Africa
| | - Eric Bouffet
- Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Simon Bailey
- Great North Children's Hospital, Newcastle upon Tyne, United Kingdom
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Riaz Q, Naeem E, Fadoo Z, Dev M, Mushtaq N. BIOL-02. INTRACRANIAL TUMORS IN CHILDREN: A 10 YEAR REVIEW FROM A SINGLE TERTIARY HEALTH CARE CENTRE. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox083.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mushtaq N, Usman S. MEDU-08. INCIDENCE OF POSTERIOR FOSSA SYNDROME IN CHILDREN AT A TERTIARY CARE HOSPITAL IN KARACHI. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox083.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sharif M, Ashraf MS, Mushtaq N, Nawaz H, Mustafa MI, Ahmad F, Younas M, Javaid A. Influence of varying levels of dried citrus pulp on nutrient intake, growth performance and economic efficiency in lambs. Journal of Applied Animal Research 2017. [DOI: 10.1080/09712119.2017.1294540] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- M. Sharif
- Institute of Animal Sciences, University of Agriculture, Faisalabad, Pakistan
| | - M. S. Ashraf
- Institute of Animal Sciences, University of Agriculture, Faisalabad, Pakistan
| | - N. Mushtaq
- Institute of Animal Sciences, University of Agriculture, Faisalabad, Pakistan
| | - H. Nawaz
- Institute of Animal Sciences, University of Agriculture, Faisalabad, Pakistan
| | - M. I. Mustafa
- Institute of Dairy Sciences, University of Agriculture, Faisalabad, Pakistan
| | - F. Ahmad
- Institute of Animal Sciences, University of Agriculture, Faisalabad, Pakistan
| | - M. Younas
- Institute of Dairy Sciences, University of Agriculture, Faisalabad, Pakistan
| | - A. Javaid
- Madina Cattle Farm, Madina Sugar Mill, Chiniot, Pakistan
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Hessissen L, Amayiri N, Mushtaq N, Sirachainan N, Anacak Y, Mitra D, Figaji A, Meeteren ASV, Sullivan M, Davidson A, Parkes J, Bouffet E, Bailey S. LMI-01DEVELOPMENT OF CLINICAL GUIDELINES FOR THE TREATMENT OF LOW GRADE GLIOMAS IN LOWER AND LOWER MIDDLE INCOME COUNTRIES – A SIOP PODC INITIATIVE. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now077.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Brugha R, Mushtaq N, McCarthy NE, Stagg AJ, Grigg J. Respiratory tract dendritic cells in paediatric asthma. Clin Exp Allergy 2015; 45:624-31. [PMID: 25411998 DOI: 10.1111/cea.12457] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 10/06/2014] [Accepted: 10/08/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Airway dendritic cells (DC) are critical mediators of lung inflammation in asthma, but the characteristics of DC in the airways of healthy children, and children with asthma, are currently unknown. OBJECTIVE We sought to identify changes in DC subset distribution and activation profile in paediatric asthma using flow cytometry to analyse induced sputum samples obtained from healthy and asthmatic children. METHODS Lung function and atopic status were determined by spirometry and skin prick testing. Induced sputum samples were analysed using 7-colour flow cytometry to identify airway DC populations (lineage(-) HLA-DR(+) sputum cells expressing either CD11c as conventional DC or CD123 as plasmacytoid DC). RESULTS Sputum samples containing lower airway plugs were obtained from 10 healthy children and 8 children with asthma. Lineage(-) HLA-DR(+) DC were successfully identified in all samples, and DC comprised a significantly higher proportion of sputum cells in children with asthma compared with age-matched healthy controls (1.29% vs. 0.67%, P = 0.02). DC expression of the costimulatory marker CD86 was significantly reduced in asthmatic children (73.4% vs. 59.7%, P = 0.04). Sputum DC also included numerous CD1c(+) cells (mean 57% of the total DC population) and low frequencies of cells expressing the subset markers CD141 or CD123, although the proportions of these did not differ between groups. CONCLUSIONS Airway DC can be identified and characterized non-invasively using flow cytometry to analyse paediatric sputum samples. Our data reveal that children with steroid-treated asthma exhibit increased frequency of airway DC with reduced expression of the costimulatory marker CD86, suggesting altered trafficking and/or maturation of these cells either due to asthma or steroid therapies.
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Affiliation(s)
- R Brugha
- Asthma UK Centre for Applied Research, Centre for Paediatrics, Blizard Institute, Queen Mary, University of London, London, UK
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Abstract
INTRODUCTION Congenital infantile fibrosarcoma (CIFS) is a soft tissue sarcoma of infants mainly involving lower extremities usually presenting during the first year of life. A subset of cases occur in the head and neck, but scalp involvement is exceptionally rare. PATIENTS AND METHODS We report clinicopathological features of three cases of CIFS involving the scalp diagnosed between 2011 and 2012. RESULTS The ages of the three patients at the time of diagnosis ranged from 12 to 90 days (mean 48 days). All were males and presented with scalp swelling at birth which grew rapidly in size. The tumor was located in the left temporal region in two cases and the right temporoparietal region in one case. On imaging, underlying bone involvement was noted in two cases. The mean size of the resected tumors was 8 cm. All cases exhibited a cellular tumor arranged in sheets of uniform oval to spindle cells, increased mitosis, and hemangiopericytoma-like vessels. All patients are alive after a mean follow-up of 39.6 months. Recurrence was seen in one case due to incomplete excision. No metastasis was seen in any of the cases. CONCLUSION CIFS of the scalp is rare and carries a good prognosis. Underlying bone erosion is rare but was noted seen in two of our cases. A male predominance was seen in our cases.
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Affiliation(s)
- Nasir Ud Din
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital Karachi, Karachi, Pakistan.
| | - Khurram Minhas
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital Karachi, Karachi, Pakistan.
| | | | - Naureen Mushtaq
- Department of Oncology, Aga Khan University Hospitali Karachi, Karachi, Pakistan.
| | - Zehra Fadoo
- Department of Oncology, Aga Khan University Hospitali Karachi, Karachi, Pakistan.
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Chattopadhyaya I, Gupta S, Mohammed A, Mushtaq N, Chauhan S, Ghosh S. Erratum to: Neuroprotective effect of Spirulina fusiform and amantadine in the 6-OHDA induced Parkinsonism in rats. Altern Ther Health Med 2015; 15:320. [PMID: 26354108 PMCID: PMC4564969 DOI: 10.1186/s12906-015-0855-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 09/08/2015] [Indexed: 11/10/2022]
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Chattopadhyaya I, Gupta S, Mohammed A, Mushtaq N, Chauhan S, Ghosh S, Ghosh S. Neuroprotective effect of Spirulina fusiform and amantadine in the 6-OHDA induced Parkinsonism in rats. BMC Complement Altern Med 2015; 15:296. [PMID: 26306668 PMCID: PMC4548915 DOI: 10.1186/s12906-015-0815-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 08/10/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Multi-factorial etiology exists in pathophysiology of neurodegenerative diseases. The imbalance of anti-oxidant enzymes and dopamine level leads to Parkinsonism. The objective of this study was to assess the protective effect of Spirulina fusiform alone and in combination with amantadine against Parkinsonism effect in 6-hydroxydopamine (6-OHDA) induced rat model. METHODS S. fusiform was administered in different groups (500 mg/kg, once daily and twice daily) and a combination of spirulina (500 mg/kg, once daily) with amantadine (20 mg/kg once daily) for 30 days before and 14 days after a single injection of 6-OHDA into the dorsal striatum. Post lesion produced rotational behavior which was measured at two week intervals (37th and 44th day). Locomotors activity was also done at 44th and muscle coordination at 48th day. Dorsal striatum was isolated from rat brain for evaluating the antioxidant assays and dopamine content at 49th day. RESULTS Both the body rotations (ipsilateral and contralateral) were found to have a statistically significant (p<0.001) decrease by 34.26 and 52% after treatment with spirulina (Twice a day) in spirulina treated lesioned group. A higher percentage of improvement was shown in the reduction of ipsilateral (57.34%) and contralateral (78.3%) rotations in combination of spirulina with amantadine treated lesioned group rather than spirulina alone treated lesioned groups when compared with positive control lesioned group. Body movements and locomotor activity were improved statistically (p<0.0001) significant in both treated lesioned groups (Combination of spirulina with amantadine and spirulina twice daily). Similar results were also seen in anti-oxidant levels which later on reached to the normal value. The levels of dopamine content had a statistically significant (p<0.0001) increase by 78.3% only in case of spirulina with amantadine treated lesioned group. CONCLUSION Spirulina is a potent nutraceutical supplement all over the world, so my preclinical study may contribute to give an additional adjuvant drug therapy in aging related disorders (Neurodegenerative as well as diabetes associated neurodegenerative disorders).
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Affiliation(s)
- I Chattopadhyaya
- Department of Pharmacology, M. M. College of Pharmacy, M. M. University, Mullana, (Ambala), Haryana, India
| | - Sumeet Gupta
- Department of Pharmacology, M. M. College of Pharmacy, M. M. University, Mullana, (Ambala), Haryana, India.
| | - Asad Mohammed
- College of Applied Medical Sciences, Shaqra University, Shaqra, Saudi Arabia
| | - N Mushtaq
- Department of Pharmacology, M. M. College of Pharmacy, M. M. University, Mullana, (Ambala), Haryana, India
| | - S Chauhan
- Department of Pharmacology, M. M. College of Pharmacy, M. M. University, Mullana, (Ambala), Haryana, India
| | - Saikat Ghosh
- FDD-NDDS Lipid Research Group, Sun Pharma Advance Research Centre, Vadodra, Gujarat, India
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Brugha R, Mushtaq N, Dundas I, Sanak M, Grigg J. S65 Urinary Prostaglandins As Inflammatory Markers For Childhood Asthma Exacerbations. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Whitehouse A, Brugha R, Mushtaq N, Dundas I, Grigg J. S64 Eosinophil Cationic Protein And Cytokine Analysis In Exhaled Breath Condensate In Paediatric Asthma. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.70] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Dev M, Mushtaq N, Faisal A. A case of autoimmune haemolytic anaemia achieving complete response with rituximab. J PAK MED ASSOC 2014; 64:700-702. [PMID: 25252495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Autoimmune haemolytic anaemia is characterised by the formation of auto-antibodies that bind to the erythrocyte surface membrane, leading to haemolysis. It is the main cause of acquired extracorpuscular haemolysis in children. It can be classified according to the characteristic temperature reactivity of the red blood cell auto-antibody in warm-antibody autoimmune haemolytic anaemia (reacting at 37 degrees C) and cold-antibody autoimmune haemolytic anaemia (reacting optimally at lower temperature). Glucocorticoids and/or intravenous immunoglobulins are the mainstay of treatment in majority of patients with warm autoimmune haemolytic anaemia, but when these treatments fail, patients often require cytotoxic drugs or splenectomy. Rituximab, an anti-CD 20 monoclonal antibody, has gained widespread acceptance in the management of B-Cell malignancies. Additionally, it has been used to treat the disorders associated with auto-antibody production. We describe a 9-year-old boy with warm autoimmune haemolytic anaemia resistant to the standard treatment who was successfully treated with Rituximab.
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Mushtaq N, Alam MM, Aslam S, Fadoo Z. Malignant mediastinal mass in children: a single institutional experience from a developing country. J PAK MED ASSOC 2014; 64:386-389. [PMID: 24864629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To determine the clinical spectrum and management outcomes of paediatric patients with modiastinal mass in a Karachi hospital. METHODS Medical records of all cases of mediastinal masses in children diagnosed and treated between January 2005 and December 2011 were retrospectively reviewed to evaluate the mode of presentation, histopathological diagnosis, radiologic findings and management outcomes at Aga Khan University Hospital, Karachi, Pakistan. SPSS 19 was used for data analysis. RESULTS A total of 37 patients of mediastinal masses were identified, and malignancy was found in 32 (86%) cases. The median age at diagnosis was 9 years (interquartile range: 4.7 years). Lymphoma 23 (72%) and leukaemia 8 (25%) were the most common causes of mediastinal mass. Nonspecific symptoms such as fever 26 (81%), cough 15 (47%) and dyspnoea 12 (37%) constituted the most commonly presenting complaints. Overall, 22 (68.7%) patients underwent surgical procedures (complete/partial resection of mass); local lymph node biopsy was performed in 5 (15.6%) cases; and computed tomography or ultrasound-guided biopsy was done in 2 (5.4%) patients. Besides, 27 (84.4%) patients were admitted to paediatric intensive care unit for supportive care, and assisted ventilation was required in 20 (62.5%) patients. The mean length of hospital stay was 9.3 +/- 6 days. None of the patients died due to complications related to mediastinal mass or diagnostic procedure. CONCLUSIONS Although mortality rate has reduced significantly with refinements in the management protocols, but a high index of suspicion and comprehensive multidisciplinary approach is crucial to improve the morbidity and mortality.
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Alam MM, Qamar FN, Khan ZW, Kumar V, Mushtaq N, Fadoo Z. Risk factors for complicated varicella infection in pediatric oncology patients at a tertiary health care facility in Pakistan. J Infect Dev Ctries 2014; 8:215-20. [DOI: 10.3855/jidc.3106] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 01/02/2014] [Accepted: 03/03/2013] [Indexed: 10/31/2022] Open
Abstract
Introduction: Varicella zoster infection (VZI) is well recognized as a potential cause of morbidity and mortality in immunocompromised pediatric oncology patients (POP). The purpose of this study was to describe the clinical profile and risk factors for complications and outcomes of VZI in POP treated with acyclovir. Methodology: Medical records of all POP with a discharge diagnosis of VZI over a period of seven years (2005-2011) were reviewed. The demographic features, underlying malignancy, risk factors for VZI, complications, and outcomes were recorded. Results: Thirty-six POP with VZI were identified. Leukemia was the most common underlying malignancy (n = 20, 58.8%), followed by lymphoma (n = 7, 20.6%) and solid organ tumors (n = 7, 20.6%). Most of the cases (41%) were observed in children under five. All patients were treated with acyclovir. Varicella-related complications developed in 10 (29%) patients. The most frequent complication was bloodstream infection (n = 3, 8.8%), followed by pneumonia (n = 2, 5.9%), skin infection (n = 2, 5.9%), hepatitis, renal failure, and encephalitis. Independent risk factors associated with complications were age < five years, weight for age < fifth percentile, delay in seeking care (> seven days after onset of symptoms) and severe neutropenia (ANC < 500/cm). One child died secondary to varicella encephalitis. Conclusion: Our data suggests that young age, poor health-seeking behavior, severe neutropenia, and being underweight are the major risk factors for the development of varicella-related complications in POP in developing countries. These complications could be favorably modified through active immunization of immunocompetent children.
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