Treatment of childhood acute lymphoblastic leukemia in Iraq: a 17-year experience from a single center

Al‐Hadad, Salma Abbas; Al‐Jadiry, Mazin Faisal; Ghali, Hasanein H.; Al‐Badri, Safaa A. Faraj; Al‐Saeed, Raghad Majid; Al‐Darraji, Amir Fadhil; Sabhan, Ahmed Hatem; Fadhil, Samaher Abdulrazzaq; Hussein, Hanadi Munaf; Abed, Wisam Majeed; Ameen, Najiha Ahmed; Sahan, Jawad Kadhum Abid; Jaafar, Ghufran Qassim; Abed, Aseel Rashid; Mohamed, Sara; Moleti, Maria Luisa; Piciocchi, Alfonso; Foà, Robin; Testi, Anna Maria

doi:10.1080/10428194.2021.1961237

Cited by 6 publications

(16 citation statements)

References 39 publications

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“…Recent advances in the treatment of childhood acute lymphoblastic leukemia (ALL) has significantly improved outcomes with long-term survival of greater than 90% in high-income countries (Hunger et al, 2012;Jeha et al, 2019). However, the survival in resource-limited countries is significantly lower compared to high-income countries with long-term survival of around 70% (Abdelmabood et al, 2020;Al-Hadad et al, 2021;Jaime-Pérez et al, 2016Viana et al, 2015). Various studies have reported relapse rates of 10-40% in patients with childhood ALL, which remains the most common cause of treatment failure, and these patients are more likely to die (Abdelmabood et al, 2020;Al-Hadad et al, 2021;Jaime-Pérez et al, 2016Locatelli et al, 2012;Olbara et al, 2021;Oskarsson et al, 2016;Tuong et al, 2020;Viana et al, 2015;Zapata-Tarrés et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

“…However, the survival in resource-limited countries is significantly lower compared to high-income countries with long-term survival of around 70% (Abdelmabood et al, 2020;Al-Hadad et al, 2021;Jaime-Pérez et al, 2016Viana et al, 2015). Various studies have reported relapse rates of 10-40% in patients with childhood ALL, which remains the most common cause of treatment failure, and these patients are more likely to die (Abdelmabood et al, 2020;Al-Hadad et al, 2021;Jaime-Pérez et al, 2016Locatelli et al, 2012;Olbara et al, 2021;Oskarsson et al, 2016;Tuong et al, 2020;Viana et al, 2015;Zapata-Tarrés et al, 2021). Patients with relapsed ALL have inferior outcomes with long-term survival of 58-72% in high-income countries (Lew et…”

Section: Introductionmentioning

confidence: 99%

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Relapsed Childhood Acute Lymphoblastic Leukemia: Experience from a Single Tertiary Center in Thailand

Chotsampancharoen

Songthawee

Chavananon

et al. 2022

Asian Pac J Cancer Prev

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Background:The outcomes of relapsed childhood acute lymphoblastic leukemia (ALL) in developed countries have improved over time as a result of risk-adapted, minimal residual disease-directed therapy, hematopoietic stem cell transplantation, and immunotherapy. There are few studies that have examined survival in relapsed childhood ALL in resource-limited countries. Therefore, this study aimed to assess the prognostic factors and survival outcome of relapsed childhood ALL in a major tertiary center in Southern Thailand. Methods: The medical records of patients with ALL aged <15 years between January 2000 and December 2019 were retrospectively reviewed. The Kaplan-Meier method was used to depict the overall survival (OS). Results: A total of 472 patients with ALL were enrolled and relapsed ALL was found in 155 (32.8%) patients. Of these, 131 (84.5%) and 24 (15.5%) had B-cell and T-cell phenotypes, respectively. One hundred thirteen (72.9%) and 42 (27.1%) patients had early and late relapses, respectively. The most common site of relapse was bone marrow in 102 patients (65.8%). One hundred twenty-eight (82.6%) patients received treatment while 27 (17.4%) patients refused treatment. The 5-year OS of all relapsed patients was 11.9%. The 5-year OS among the patients with early relapse was significantly lower than in the patients with late relapse (5.3% vs. 29.1%, respectively, p <0.0001). Site and immunophenotype were not associated with survival of relapsed ALL. The median survival times among the patients who received and refused relapse chemotherapy were 11.8 and 3.1 months, respectively (p <0.0001). Conclusion: The relapse rate accounted for one third of patients with ALL with the 5-year OS of 12%. Early relapse and those who refused treatment were associated with poor survival outcome.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Relapsed Childhood Acute Lymphoblastic Leukemia: Experience from a Single Tertiary Center in Thailand

Chotsampancharoen

Songthawee

Chavananon

et al. 2022

Asian Pac J Cancer Prev

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“…Although this comprehensive initiative to improve the outcomes of Iraqi children specifically focused on patient care and building local capacity, it also promoted research at CWTH, culminating in several peer‐reviewed publications. In addition to 12 publications produced by the Simona‐TOGETHER Project, 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 researchers at CWTH presented six posters and three oral presentations at international and regional conferences. Such research outcomes are important for the CWTH clinical investigators' professional development and acknowledgement at both regional and international levels.…”

Section: Resultsmentioning

confidence: 99%

“… 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 Italy was one of the first Western countries to commit to supporting health care systems in Iraq. This was evident in different projects addressing the care for patients with various cancer types, such as promyelocytic leukemia, 11 acute lymphoblastic leukemia, 12 lymphoma, 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 Wilms tumor, 21 and rare tumors. 22 Here, we describe the outcomes of the telemedicine and twinning experience in pediatric oncology between Sapienza University of Rome and CWTH in Baghdad.…”

Section: Introductionmentioning

confidence: 99%

Comprehensive global collaboration in the care of 1182 pediatric oncology patients over 12 years: The Iraqi–Italian experience

et al. 2022

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Background Iraq's health care system has gradually declined after several decades of wars, terrorism, and UN economic sanctions. The Oncology Unit at Children's Welfare Teaching Hospital (CWTH) in Baghdad was lacking basic facilities and support. To address this shortcoming, a humanitarian and educational partnership was established between CWTH and Sapienza University of Rome (SUR). Methods We investigated the outcomes of 80 online and 16 onsite educational sessions and 142 teleconsultation sessions from 2006 to 2014. We also determined the outcomes of pathology reviews by SUR of 1216 tissue specimens submitted by CWTH from 2007 until 2019 for second opinions. The primary outcomes were discordance, concordance, and changes among clinical diagnoses and pathology review findings. The measures included the frequency of teleconsultation and tele‐education sessions, the topics discussed in these sessions, and the number of pathology samples requiring second opinions. Findings A total of 500 cases were discussed via teleconsultations during the study period. The median patient age was 7 years (range, 24 days to 16·4 years), and the cases comprised 79 benign tumors, 299 leukemias, 120 lymphomas, and 97 solid tumors. The teleconsultation sessions yielded 27 diagnostic changes, 123 confirmed diagnoses, and 13 equivocal impacts. The pathology reviews by SUR were concordant for 996 (81·9%) cases, discordant for 186 (15·3%), and inconclusive for 34 (2·8%). The major cause of discordance was inadequate immunohistochemical staining. The percentage of discordance markedly decreased over time (from 40% to 10%). The cause of the improvement is multifactorial: training of two CWTH pathologists at SUR, better immunohistochemical staining, and the ongoing clinical and pathologic telemedicine activities. The partnership yielded 12 publications, six posters, and three oral presentations by CWTH investigators. Interpretation The exchange of knowledge and expertise across continental boundaries meaningfully improved the diagnoses and management of pediatric cancer at CWTH.

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“…With a 5-year OS of 76.7% and RFS of 73.3%, the overall outcome from this cohort study is lower than several published from developed Western countries with countries like the Netherlands and Germany which reported a 5-year OS of 91% and 91.8% respectively 13,15 , and some developing countries such as Jordan were also reported to have a 5-year OS and RFS of 89% and 80% respectively 12 . Interestingly a recent paper published from Children Welfare Teaching Hospital in Baghdad, Iraq revealed a lower 5-year RFS and 5-year OS rate (of 62.2%,46.3% respectively) 16 . The lower 5-year OS and RFS might be related to poor adherence to therapeutic guidelines and the lack of BMT in certain high-risk patients due to financial constraints and/or a lack of local BMT.…”

Section: Discussionmentioning

confidence: 95%

Hematological Predictors of Outcome in Childhood Acute Lymphoblastic Leukemia in Duhok

IBRAHIM

AL-DOSKI²,

MUHSIN³

2022

dmj

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Background: While numerous studies have addressed the outcome of childhood acute lymphoblastic leukemia (ALL) in western developed countries, there is a scarcity of data in developing countries. This study explores the hematological predictors of outcomes in childhood acute lymphoblastic leukemia in Duhok city-Kurdistan Iraq. Method: the current study represents a cross-sectional study, conducted in Hivi Pediatric hospital and Zheen oncology center in Duhok, Iraq, and 116 patients were enrolled. The main features of childhood ALL, hematological predictors, type of therapy, and risk factors were analyzed to assess their effect on treatment outcome and survival rate. Results: Median age of the study cohort was 5 years and the male-to-female ratio of 1.4:1. 87.9% of the cases were B-ALL while 12.1 were T-cell. Blood counts revealed a mean WBC count of 54.34 x 109/L, mean hemoglobin of 7.913 g/dl, and mean platelet count of 68.96 x 109/L. Complete remission (CR) rate was 92.2%, the overall 5-year survival (OS) was 76.7%, and relapse-free 5-year survival (RFS) was 73.3%. Patients with B-cell ALL had significantly higher OS compared to patients with T-cell (p value=0.01). Patients stratified into high-risk groups had significantly lower RFS and OS compared to the intermediate and standard risk groups (p value=0.04, 0.008 respectively). Patients aged >10 years had significantly lower RFS (p value=0.001). Other factors such age<1 year, PLT count, Hb count, and gender did not predict poor outcome Conclusion: Immunophenotype, age>10 years and risk stratification are important predictors of outcome in childhood ALL in our study, most notably, the patients' survival rates were inferior to similar reports from western developed countries, The key areas for future work should include wider implementation of MRD and cytogenetic analysis in risk stratification to improve the outcome of childhood ALL.

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Treatment of childhood acute lymphoblastic leukemia in Iraq: a 17-year experience from a single center

Cited by 6 publications

References 39 publications

Relapsed Childhood Acute Lymphoblastic Leukemia: Experience from a Single Tertiary Center in Thailand

Relapsed Childhood Acute Lymphoblastic Leukemia: Experience from a Single Tertiary Center in Thailand

Comprehensive global collaboration in the care of 1182 pediatric oncology patients over 12 years: The Iraqi–Italian experience

Hematological Predictors of Outcome in Childhood Acute Lymphoblastic Leukemia in Duhok

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