Heba A. Sayed

Treatment results and prognostic factors of pediatric neuroblastoma: a retrospective study

Background We conducted a retrospective analysis to investigate treatment results and prognostic factors of pediatric neuroblastoma patients. Methods This retrospective study was carried out analyzing the medical records of patients with the pathological diagnosis of neuroblastoma seen at South Egypt Cancer Institute, Assiut University during the period from January 2001 and January 2010. After induction chemotherapy, response according to international neuoblastoma response criteria was assessed. Radiotherapy to patients with residual primary tumor was applied. Overall and event free survival (OAS and EFS) rates were estimated using Graphed prism program. The Log-rank test was used to examine differences in OAS and EFS rates. Cox-regression multivariate analysis was done to determine the independent prognostic factors affecting survival rates. Results Fifty three cases were analyzed. The median follow-up duration was 32 months and ranged from 2 to 84 months. The 3-year OAS and EFS rates were 39.4% and 29.3% respectively. Poor prognostic factors included age >1 year of age, N-MYC amplification, and high risk group. The majority of patients (68%) presented in high risk group, where treatment outcome was poor, as only 21% of patients survived for 3 year. Conclusion Multivariate analysis confirmed only the association between survival and risk group. However, in univariate analysis, local radiation therapy resulted in significant survival improvement. Therefore, radiotherapy should be given to patients with residual tumor evident after induction chemotherapy and surgery. Future attempts to improve OAS in high risk group patients with aggressive chemotherapy and bone marrow transplantation should be considered.

The Outcome of Critically Ill Pediatric Cancer Patients Admitted to the Pediatric Intensive Care Unit in a Tertiary University Oncology Center in a Developing Country: A 5-Year Experience.

Introduction: Cancer remains a major cause of death in children, but recent advances in supportive care and progress in the use of chemotherapy have considerably improved the prognosis. The need for intensive care management in pediatric oncology patients is increasing. However, studies demonstrating their outcome in the literature are still deficient, especially in developing countries. Here, we aim to report our experience in managing patients admitted to the pediatric intensive care unit (PICU) at South Egypt Cancer Institute, a tertiary university oncology center in a developing country. Patients and Methods: A review of all cancer patients admitted to the PICU at South Egypt Cancer Institute between January 2007 and December 2011 and an evaluation of prognostic factors that may correlate to their short-term outcome were performed. Results: A total of 550 pediatric oncology patients were admitted to the PICU on 757 occasions. Hematological malignancies represented 73.6% of the cases. The median duration of PICU stay was 5 days. Sepsis and respiratory failure were the most frequent indications for PICU admission. The overall survival at the time of discharge from the PICU was 60%. Several factors were found to significantly affect the outcome of patients admitted to the PICU, including the underlying disease, the reason for admission, the intervention used, and the number of failing organs at the time of admission to the PICU. Conclusions: The prognosis of patients admitted to the PICU in developing countries is still behind those in developed ones. Late referral, especially of patients presenting with respiratory failure, sepsis, and multiorgan failure usually, requires urgent intervention with inotropic support, oxygen therapy, and mechanical ventilation and is significantly associated with poor outcomes, especially in patients with hematological malignancies.

Risk-based combined-modality therapy of pediatric Hodgkin's lymphoma: A retrospective study

We conducted a retrospective analysis to investigate the clinical outcome of combined-modality therapy using multiagent chemotherapy and involved-field radiotherapy in treatment of children with Hodgkins lymphoma. Fifty eight cases with newly diagnosed Hodgkins lymphoma were analyzed. The median follow-up duration was 46 months (range 3-72 months). The 4-year overall and event-free survival rates were 91.5% and 69.7% respectively. High-risk disease (stage IIIB and IV), presence of B symptoms, lymphocyte depletion subtype, bulky disease and late response to chemotherapy were poor prognostic factors. Stage-adapted combined-modality therapy resulted in satisfactory outcome in treatment of pediatric Hodgkins lymphoma.

Acute Complications After High-Dose Chemotherapy and Stem-Cell Rescue in Pediatric Patients With High-Risk Neuroblastoma Treated in Countries With Different Resources

Purpose High-dose chemotherapy with autologous stem-cell rescue (SCR) is a key component of high-risk neuroblastoma (HRNB) therapy. Carboplatin, etoposide, and melphalan (CEM) or busulfan and melphalan (Bu/Mel) are the most evaluated, effective high-dose chemotherapy for HRNB on the basis of results from major cooperative group studies. Toxicity profiles vary between these regimens, and practice variation exists regarding the preferred high-dose therapy (HDT). We sought to evaluate the safety of HDT and autologous SCR for HRNB in a resource-limited country (Egypt) compared with the resource-rich United States. Patients and Methods We performed a retrospective comparative review of single CEM-based HDT/SCR outcomes through day 100 for HRNB at the Fred Hutchinson Cancer Research Center (FH) in the United States (2005 to 2015) versus Bu/Mel-based HDT at El-Sheikh Zayed Specialized Hospital (SZ) in Egypt (2009 to 2015). Results Forty-four patients at FH and 77 patients at SZ were reviewed. Pretransplant hepatic comorbidities were significantly higher at SZ (29 of 77 v nine of 44; P = .05), with 19 of 77 patients at SZ having hepatitis infection. Engraftment was delayed after SZ-Bu/Mel therapy compared with FH-CEM therapy for neutrophils (median 12 days v 10 days, respectively; P < .001) and platelets (median 20 days v 18 days, respectively; P < .001). Sinusoidal obstruction syndrome occurred later, after SZ-Bu/Mel therapy (median 19 days v 7 days; P = .033), and four of eight cases were fatal (six of eight patients had underlying hepatitis infection), whereas three of three cases after FH-CEM therapy were moderately severe. Resource utilization associated with the number of days with fever, antibiotic use, and the number of transfusions administered was significantly higher after FH-CEM therapy than after SZ-Bu/Mel therapy. Conclusion Use of autologous stem-cell transplantation is feasible in the context of a resource-limited country.

Outcome and Clinical Significance of Immunophenotypic Markers Expressed in Different Treatment Protocols of Pediatric Patients With T-ALL in Developing Countries

Micro‐Abstract This study aimed to evaluate pediatric patients had T‐cell acute lymphoblastic leukemia (T‐ALL) at two different Arabic cancer centers regarding their clinic‐pathologic, immunophenotypic and cytogenetic features and outcome. Study included 103 patients with median age of 8.9 years. Male to female ratio was 2.6:1. Patients divided into (group I) treated with BFM‐90 treatment protocol between February 2003 and June 2007 and (group II) includes all patients treated thereafter by the total therapy study XIII protocol for high‐risk ALL. Outcome of patients with T‐ALL significantly improved in patients received treatment protocol of ALL with high‐risk criteria. This protocol eliminates the bad outcomes effect of several clinical and immunophenotypic markers. Background: T‐cell acute lymphoblastic leukemia (T‐ALL) accounts for about 15% of pediatric ALL. With wider use of intensive chemotherapy, the prognosis for childhood T‐ALL has improved. Further gains in treatment outcome will likely require methods to identify patients who continue to fail on contemporary protocols. This study aimed to evaluate pediatric patients with T‐ALL at 2 different Arabic cancer centers regarding their clinicopathologic, immunophenotypic, and cytogenetic features and outcome. Patients and Methods: This retrospective study included all children with T‐ALL treated between 2003 and 2013 at 2 oncology centers in the Middle East. Patients were divided into (group I) treated with Berlin‐Frankfurt‐Münster (BFM)‐90 treatment protocol between February 2003 and June 2007 and (group II) includes all patients treated thereafter by the Total Therapy Study XIII protocol for high‐risk ALL. Results: This study included 103 patients with a median age of 8.9 years. The male to female ratio was 2.6:1. The median initial white blood cell count was 123 × 109/L. Central nervous system leukemia was detected in 15%. The early T‐cell precursor (ETP)‐ALL phenotype was found in 16.5%. The 5‐year overall survival was 20.7% ± 67.5% and 72.9% ± 5.7% (P < .01); the 5‐year disease‐free survival was 47.1% ± 13.8% and 77.3% ± 6.0% (P = .023); and the 5‐year event‐free survival was 28.6% ± 12.1% and 71.1% ± 6.2% (P = .003) for group I and II, respectively. Conclusion: The outcome of patients with T‐ALL significantly improved in patients who received the treatment protocol of ALL with high‐risk criteria. This protocol eliminates the bad outcomes effect of several clinical and immunophenotypic markers. Patient with the ETP‐ALL phenotype had a nonsignificant inferior outcome compared with the non–ETP‐ALL group.

Sacrococcygeal tumors: clinical characteristics and outcome of pediatric patients treated at South Egypt Cancer Institute. A retrospective analysis.

BACKGROUND Sacrococcygeal tumors (SCT) are relatively uncommon tumors affecting neonates, infants and children. The aim of this article is to clarify any special characterizations in natural history, clinical presentation and outcome of such tumors treated at South Egypt Cancer Institute, the only research center located in South Egypt. METHODS A retrospective analysis of children with SCT treated at the Pediatric Oncology department South Egypt Cancer Institute, Assiut University between 2004 and 2010. RESULTS Nineteen children were included in the study. Age ranged between 10 days and 5 years. All but three had sacral mass at presentation. AFP levels ranged between normal age-related levels and 217,200 ng/ml. Initial resection was possible in 11, while eight patients with clinical suggestion of advanced malignant disease were inoperable. They received initial chemotherapy followed by delayed surgery. Yolk sac tumor (YST) was reported in 52.9% of patients. Recurrence was reported in 5 patients (3 mature teratomas and 2 YST). Five-year OS and RFS rates of patients who had malignant disease were 81.8% and 77.8% respectively. CONCLUSIONS Older age and delay in presentation that resulted in predominance of extensive disease and malignant transformation at presentation were the main challenges we faced in managing patients with SCT in our locality.

Long-term Follow-up of Infantile Wilms Tumor Treated According to International Society of Pediatric Oncology Protocol: Seven Years' Follow-up

OBJECTIVES To report the long-term follow-up of patients with infantile Wilms tumor treated according to the International Society of Pediatric Oncology study 9 protocol. METHODS We retrospectively reviewed our medical reports for diagnosed WT in patients aged 6-12 months from January 2001 to January 2009. The clinical presentation, stage, operative details, pathologic findings, and outcomes for these infants were analyzed. We reviewed the charts of these patients throughout the whole disease course through long-term follow-up, paying particular attention to the details of the clinical presentation, stage at presentation versus postoperative stage, intraoperative findings, pathologic findings, and outcomes. RESULTS The records revealed 16 patients with a median age of 7.5 months. All patients had presented with an abdominal mass, and 25% had presented with abdominal pain and hematuria. Associated congenital anomalies were observed in 16.7% of the patients. A favorable histologic type was found in 91.7% of the patients and 8.3% had an unfavorable histologic type. The median follow-up period was 57 months. Postoperative complete remission was achieved in all patients who underwent surgery. Relapse developed in 1 patient. The 7-year disease-free survival rate was 93.8%, and the 7-year overall survival rate was 75%. CONCLUSIONS The long-term follow-up data using the International Society of Pediatric Oncology study 9 protocol revealed good outcomes. The protocol was a safe and an effective line of therapy, associated with decreased morbidity and improved survival. Also, the reduction in tumor volume resulted in easier surgical procedures, with no intraoperative complications.