Comparison of Long-Term Outcome Between Belgian and Vietnamese Children Treated for Acute Lymphoblastic Leukaemia According to the Same Protocol

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4292-4292
Author(s):  
Phuong Thu Vu Hoang
Keyword(s):  
United States ◽  
Acute Lymphoblastic Leukaemia ◽  
Regression Model ◽  
Lymphoblastic Leukaemia ◽  
East Asian ◽  
The United States ◽  
Relapse Free Survival ◽  
Childhood All ◽  
Free Survival ◽  
Risk Of Death

Abstract Abstract 4292 Introduction Acute lymphoblastic leukaemia (ALL) is the most common type of childhood cancer in East Asian, Caucasians and in the United States. Previous studies have shown poorer survival from childhood ALL among Asian compared to Caucasian populations. The US National Cancer Institute's Surveillance, Epidemiology and End Results program from 1998 to 2008 showed that poorer prognosis waseven observed in East Asian children living in the United States, compared to non-Hispanic Whites. This finding is interesting in that Asian ethnic groups are not socioeconomically disadvantaged in the United States relative to non-Hispanic whites as shown by US Census data. Aim The primary goal of this study was to compare the outcome of Belgian and Vietnamese children with ALL, treated with the same protocol (French acute lymphoblastic leukemia protocol FRALLE). Patients and Methods The Belgian series included 107 patients (aged less than 19 at diagnosis) followed at Cliniquesuniversitaires Saint-Luc (UCL), Brussels, Belgium between 2001 and 2011. The Vietnamese series included 166 patients from Blood Transfusion and Hematology Hospital, University of Medicine Pham Ngoc Thach (UPNT) at Ho Chi Minh city, Vietnam (aged less than 16 at diagnosis) and followed between 2005 and 2011. Clinical andbiologicalvariables and survival rates were compared using Cox Proportional Hazards Regression model. The association between clinicaland biological variables and both adverse drug reactions and relapse free survival were analyzed using Log-Binomial Regression model. All statistical analysis was performed using the ‘Epi’ and the ‘Survival’ package of the R 2.15.0 software. Results The two populations were comparable regarding age at diagnosis, sex ratio, initialwhite blood cell count, cytogenetic and steroid responsiveness at day 8. A higher prevalence of L2 type-ALL according to the FAB classification was found in Vietnamese children (81.3 % L2 in Vietnam vs 44.9% in Belgium). Vietnamese patients had a significantly lower survival than Belgian patients (p<0.001) (figure 1). In the multivariate analysis model, relative risk of death for Vietnamese children was 2.61 (95% CI= 1.03–6.65) (p = 0.04). Compared to the Belgian cohort, Vietnamese children had a lower relapse free survival (figure 2) and a higher relativerisk of relapse of 3.01 (95% CI = 1.53–5.93). They also disclosed a higher incidence of methotrexate-related grade 3 or 4 side effects (36.2% vs 5.6%). Conclusions Compared to Caucasians treated with the same protocol, a poorer overall survival was confirmed in children with ALL treated in Vietnam. Relapse free survival was lower and adverse reaction rate higher among Vietnamese children. Racial differences in pharmacogenetics of drugs as well as additional factors such as social status, lack of antibiotic prophylaxis or delayed access to care due to remoteness may explain these observations. Appendix Disclosures: No relevant conflicts of interest to declare.

Acute Lymphoblastic Leukaemia Has a Poor Outcome in Children with Down Syndrome Due to Infective Death in Remission (Results of UK MRC ALL 97 Trial).

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 873-873 ◽  
Author(s):  
Josu de la Fuente ◽  
Sue Richards ◽  
David K. Webb ◽  
Ian M. Hann ◽  
Christopher D. Mitchell ◽  
...  
Keyword(s):  
Down Syndrome ◽  
Acute Lymphoblastic Leukaemia ◽  
Lymphoblastic Leukaemia ◽  
High Rate ◽  
Childhood All ◽  
Free Survival ◽  
Children With Down Syndrome ◽  
Medical Research Council Trial ◽  
The Uk

Abstract Acute lymphoblastic leukaemia (ALL) has a poorer outcome in children with Down syndrome (DS) which has been attributed in the past to a higher incidence of infective death in remission and late relapses. We report on the outcome of children with DS enrolled on the UK Medical Research Council trial for childhood ALL, MRC ALL 97, between January 1997 and June 2002. Thirty seven children had DS (2%), of whom three were treated on the high risk protocol (HR1). Thirty-three (89%) achieved complete remission at the end of induction, 3 died during induction (8%), and one died later without remission. The median follow up was 4.9 years (2.4–7.8). The 5-year event free survival (EFS: 48.0%, SD 8.9) was not an improvement on the previous MRC UKALL XI trial (57.9%, SD 8.0, p=0.2) and was significantly worse than for children without DS (p&lt;0.00005). At the time of follow up, 46% of the children had died (n=17). Five patients suffered relapse, and the relapse rate was not significantly different from those without DS. One patient known to have cardiac disease died during maintenance due to arrhythmia and 8 died of infection, resulting in a significantly higher rate of death in remission (28%) than in children without DS (3%, p&lt;0.00005). Infective deaths were associated with intensification therapy, except in one child who died during interim maintenance. It was possible to isolate a microorganism in 50% of the cases (two cases of Pseudomonas, one Staphylococcus aureus, one Staphylococcus epidermidis and yeast) plus Rhinovirus was found in a nasopharyngeal aspirate of a fifth case with clinical evidence of bacterial sepsis. For the randomised comparisons (prednisolone versus dexamethasone n=30, mercaptopurine versus thioguanine n=23), results within the DS patients were not significantly different from those in all patients, with benefit for dexamethasone. The increase in remission deaths with DS was greater with prednisolone, and with mercaptopurine (p for interaction = 0.0002, &lt;0.00005, respectively). The revision of the trial in 1999 which adopted the template of CCG 1952 which improved EFS, did so for DS patients also, with no change in the DS remission death rate. In conclusion, children with DS may benefit from increased treatment intensity but still have an unacceptably high rate of infective death in remission.

scholarly journals Philadelphia chromosome-negative B-cell acute lymphoblastic leukaemia with kinase fusions in Taiwan

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yin-Chen Hsu ◽  
Chih-Hsiang Yu ◽  
Yan-Ming Chen ◽  
Kathryn G. Roberts ◽  
Yu-Ling Ni ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Acute Lymphoblastic Leukaemia ◽  
B Cell ◽  
Lymphoblastic Leukaemia ◽  
Kinase Inhibitors ◽  
Philadelphia Chromosome ◽  
Genetic Alterations ◽  
Childhood All ◽  
Free Survival ◽  
Polymerase Chain

AbstractPhiladelphia chromosome-like (Ph-like) acute lymphoblastic leukaemia (ALL), a high-risk subtype characterised by genomic alterations that activate cytokine receptor and kinase signalling, is associated with inferior outcomes in most childhood ALL clinical trials. Half of the patients with Ph-like ALL have kinase rearrangements or fusions. We examined the frequency and spectrum of these fusions using a retrospective cohort of 212 newly diagnosed patients with childhood B-cell ALL. Samples without known chromosomal alterations were subject to multiplex reverse transcription polymerase chain reaction to identify known Ph-like kinase fusions. Immunoglobulin heavy chain locus (IGH) capture and kinase capture were applied to samples without known kinase fusions. We detected known kinase fusions in five of 212 patients, comprising EBF1-PDGFRB, ETV6-ABL1, ZC3HAV1-ABL2, EPOR-IGH, and CNTRL-ABL1. Two patients with P2RY8-CRLF2 were identified. Patients with non-Ph kinase fusions had inferior 5-year event-free survival and overall survival compared with patients with other common genetic alterations. The prevalence of non-Ph kinase fusions in our Taiwanese cohort was lower than that reported in Caucasian populations. Future clinical trials with tyrosine kinase inhibitors may be indicated in Taiwan because of the inferior outcomes for B-cell ALL with kinase fusions.

scholarly journals Excess morbidity and mortality among survivors of childhood acute lymphoblastic leukaemia: 25 years of follow-up from the United Kingdom Childhood Cancer Study (UKCCS)

2021 ◽  
Author(s):  
Eleanor Kane ◽  
Sally Kinsey ◽  
Audrey Bonaventure ◽  
Tom Johnston ◽  
Jill Simpson ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukaemia ◽  
Lymphoblastic Leukaemia ◽  
Radiation Treatment ◽  
Absolute Risk ◽  
Later Life ◽  
Morbidity And Mortality ◽  
Childhood All ◽  
Risk Of Death ◽  
Childhood Acute Lymphoblastic Leukaemia

Objectives To examine morbidity and mortality in survivors of childhood acute lymphoblastic leukaemia (ALL) across their teenage and young adult (TYA) years; comparing the patterns observed with individually matched general population controls. Design Case-control study with follow-up linkage to administrative healthcare databases for up to 25 years. Setting The study population comprises all children (0-14 years) registered for primary care with the National Health Service (NHS) in England 1992-1996. Participants 1082 five-year survivors of ALL diagnosed <15 years of age, and 2018 age- and sex-matched population-based controls; followed to 15 March 2020. Main outcome measures Associations with hospital activity, cancer, and mortality were assessed using incidence rate ratios and absolute risk difference. Results Mortality 5-25 years after diagnosis was 20 times higher in cases than controls (Rate Ratio 21.3, 95% Confidence Interval 11.2-45.6), and cancer incidence 10 time higher (IRR 9.9 95% CI 4.1-29.1). Hospital activity was increased for many clinical specialties, the strongest effects being for endocrinology; outpatient IRR 36.7, 95% CI 17.3-93.4 and inpatient 19.7, 95% CI 1.9-25.5 for males, and 11.0, 95% CI 6.2-21.1 and 6.2 95% CI 3.1-13.5 respectively for females. Notable excesses were also evident for cardiology, neurology, ophthalmology, respiratory medicine and general medicine. Males were also more likely to attend gastroenterology, ENT (ear, nose and throat), urology, and dermatology; while females were more likely to be seen in plastic surgery and less likely in midwifery. Conclusions Adding to a large excess risk of death and cancer, survivors of childhood ALL experience excess outpatient and inpatient activity across their TYA years. Involving most clinical specialties, the observed effects are striking, showing no signs of diminishing over the first 25 years of follow-up. These findings underscore the need to take prior ALL drug and/or radiation treatment into account when interpreting seemingly unrelated symptoms in later life.

scholarly journals Beyond Economic Interests: Attitudes toward Foreign Workers in Australia, the United States and East Asian Countries

2014 ◽  
Vol 19 (3) ◽  
pp. 93-103 ◽  
Author(s):  
Ming-Chang Tsai ◽  
Rueyling Tzeng
Keyword(s):  
United States ◽  
Regression Model ◽  
East Asian ◽  
The United States ◽  
Foreign Workers ◽  
Economic Interest ◽  
Asian Countries ◽  
Economic Interests ◽  
Mixed Outcomes ◽  
Using Data

We compare attitudes toward foreign workers between two wealthy Western and four developing East Asian countries, using data from the 2006 and 2008 Asian Barometer surveys to test hypotheses on economic interests, cultural supremacy, and global exposure. Respondent majorities in all six countries expressed high levels of restrictivism. Regression model results indicate a consistent cultural superiority influence across the six countries, but only minor effects from economic interest factors. Mixed outcomes were noted for the global exposure variables.

Racial and Sex Disparities in Trauma Outcomes Based on Geographical Region

2020 ◽  
pp. 000313482096006
Author(s):  
William Q. Duong ◽  
Areg Grigorian ◽  
Cyrus Farzaneh ◽  
Jeffry Nahmias ◽  
Theresa Chin ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Trauma Patients ◽  
Improvement Program ◽  
Trauma Outcomes ◽  
Risk Of Death ◽  
Hospital Access ◽  
Risk Of Mortality ◽  
Sex Disparities ◽  
Male Patients

Objectives Disparities in outcomes among trauma patients have been shown to be associated with race and sex. The purpose of this study was to analyze racial and sex mortality disparities in different regions of the United States, hypothesizing that the risk of mortality among black and Asian trauma patients, compared to white trauma patients, will be similar within all regions in the United States. Methods The Trauma Quality Improvement Program (2010-2016) was queried for adult trauma patients, separating by U.S. Census regions. Multivariable logistic regression analyses were performed for each region, controlling for known predictors of morbidity and mortality in trauma. Results Most trauma patients were treated in the South (n = 522 388, 40.7%). After risk adjustment, black trauma patients had a higher associated risk of death in all regions, except the Northeast, compared to white trauma patients. The highest associated risk of death for blacks (vs. whites) was in the Midwest (odds ratio [OR] 1.30, P < .001). Asian trauma patients only had a higher associated risk of death in the West (OR 1.39, P < .001). Male trauma patients, compared to women, had an increased associated risk of mortality in all four regions. Discussion This study found major differences in outcomes among different races within different regions of the United States. There was also both an increased rate and associated risk of mortality for male patients in all regions. Future prospective studies are needed to identify what regional differences in trauma systems including population density, transport times, hospital access, and other trauma resources explain these findings.

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