M. Khattab

Treatment of B-cell lymphoma with LMB modified protocols in Africa--report of the French-African Pediatric Oncology Group (GFAOP).

The French African Paediatric Oncology Group (GFAOP) was set up in October 2000 to improve the quality of care of children with cancer in Africa. Eight pediatric oncology units from Algeria, Cameroon, Madagascar, Morocco, Tunisia, and Senegal have been involved.

Determinants of severe oral mucositis in paediatric cancer patients: a prospective study

OBJECTIVE To analyse the incidence and the determinants of severe oral mucositis (OM) in young cancer patients treated by standard chemotherapy. METHODS The study was carried out at the Pediatric Hemato-Oncology unit of Childrens Hospital of Rabat. Patients under 16 years of age with malignant disease treated by chemotherapy between January 2001 and December 2006 were recorded. RESULTS Consecutive patients (n = 970) with malignant disease were studied. The age ranges from 2 months to 16 years (mean, 6.8 ± 4.1 years). OM occurred in 540 (55.6%) patients, and 17.9% of them encountered severe grades. Mean time to onset of the lesions was 10.5 ± 6.8 (range, 1-22 days) and mean duration was 6.8 ± 3.1 (range, 2-23 days). All chemotherapeutic protocols were associated with OM development (range, 20-100%). Patients with severe OM were more likely to have undifferentiated carcinoma of nasopharyngeal type (RR = 2.6, 95% IC 1.1-6.1), non-Hodgkin lymphoma (RR = 2.1, 95% CI 1.2-2.4) and acute leukaemia (RR = 1.7, 95% CI 1.5-3.6). Methotrexate-based therapies were also associated with the worsening of OM (RR = 1.7, 95% IC 1.2-2.6). CONCLUSION Underlying disease and chemotherapy regimens are the principal risk factors of OM development. This model can help in the identification of patients at risk for adequate preventive and therapeutic measures.

SIOP‐PODC adapted risk stratification and treatment guidelines: Recommendations for neuroblastoma in low‐ and middle‐income settings

Neuroblastoma is the most common extracranial solid tumor in childhood in high‐income countries (HIC), where consistent treatment approaches based on clinical and tumor biological risk stratification have steadily improved outcomes. However, in low‐ and middle‐ income countries (LMIC), suboptimal diagnosis, risk stratification, and treatment may occur due to limited resources and unavailable infrastructure. The clinical practice guidelines outlined in this manuscript are based on current published evidence and expert opinions. Standard risk stratification and treatment explicitly adapted to graduated resource settings can improve outcomes for children with neuroblastoma by reducing preventable toxic death and relapse. Pediatr Blood Cancer 2015;62:1305–1316.

CD10 AND CD34 EXPRESSION IN CHILDHOOD ACUTE LYMPHOBLASTIC LEUKEMIA IN MOROCCO: Clinical Relevance and Outcome

CD10 and CD34 expression in 86 Moroccan children with acute lymphoblastic leukemias (ALL) and the relevance to prognosis, diagnosis, and outcome during a 5-year follow-up were examined. At diagnosis, 57% of patients had CD10+ blasts, while 35% had CD34+ blasts. The CD10+ blast frequency was much higher (80%) in B-ALL than in T-ALL (20%). The frequency of CD34+ blasts was higher in B-ALL (48%) compared to T-ALL (16%). The 5-year survival curves showed that children with CD10+ B-ALL had a significantly longer survival rate than those with CD10−, as observed for T-ALL. The survival rate of B-ALL expressing CD34 was higher than that of CD34−. Thus, CD34 and CD10 expression may have prognostic value and is associated with a better clinical outcome.

Immunologic Profile and Outcome of Childhood Acute Lymphoblastic Leukemia (all) in Morocco

Immunophenotyping in leukemia offers a precise delineation of the hematopoietic lineage and differentiation stage of the malignant cell. In this study, we used flow cytometry to determine the frequency of the immunologic types of acute lymphoblastic leukemia (ALL) in Moroccan children. We analyzed 100 samples from ALL patients within an age ranging from 6 months to 16 years presented over a 4-year period (1996 to 2000). Immunophenotyping allowed classification into 2 major categories: T-ALL (37%) and B-ALL (63%), with a higher percentage of males (69%). Comparison of the clinical characteristics showed that the frequency of splenomegaly was similar in B-ALL and T-ALL patients (53% and 47%, respectively). Hepatomegaly and mediastinal masses were more often associated with T-ALL (62% and 71%, respectively). Splenomegaly, hepatomegaly, and mediastinal masses were more frequent in immature than mature B-ALL, whereas the reverse was observed for T-ALL. Complete remission was obtained in 88% and 84% of B-ALL and T-ALL, respectively and relapse after 1 year occurred in 30% and 37% of cases, respectively. CD10 expressing B-ALL showed a slightly higher complete remission rate, whereas the reverse was observed for CD10 expressing T-ALL. The overall 5-year survival rate of ALL was 38%, whereas patients with B-ALL showed better survival than children with T-ALL.

Pediatric Hodgkins disease in Morocco

To the Editor: Hodgkin disease (HD) is one of the common malignancies in childhood [1]. With current treatments, 80–90% of all pediatric patients will be surviving without evidence of disease [2]. There is limited information regarding the management of HD in developing countries [3]. The purpose of our study was to analyze the epidemiological pattern, histology, staging, and treatment results on Moroccan children presenting with HD. We retrospectively studied 118 cases of histologically proven HD in previously untreated children under 15 years of age admitted at the Hematology and Oncology Unit of Rabat from 1995 to 2000. The protocol of treatment was the MDH 90 from the French Society of Pediatric Oncology [4]. The mean age of the patients was 8 years (range 2–15 years) with 28 patients (24%) less than 5 years. The male/female ratio was five. Consanguineous marriage was found in 10% and in two cases it was a history of familiarly HD. Histopathologic classification according to Lukes and Buttler was nodular sclerosis (NS) in 45% and mixed cellularity (MC) in 41%. The median delay of diagnosis was 6 months. Cervical lymphadenopathy was present in 116 patients (89.8%). In 59 patients (54.6%) at least one B symptom was present. Splenomegaly was found in 35% and hepatomegaly in 17% of cases. Mediastinal enlargement was found in 45%, pulmonary nodule in 4%, and pleurisies in 5%. Abdominal adenopathy was found in 43%. Bone marrow was involved in 14%, the kidney in 2.5%, the bone in 3.7%, and two patients had cutaneous nodule. Erythrocyte sedimentation rate was over 70 mm in 63%. Median of white blood cell was 8,200 element/mm and median of hemoglobin 10.2 g/dl. According to the Ann Arbor staging system 55% of patient where stage III–IV. Among the 118 patients, 117 were treated and 34% received treatment conforming to the protocol. Involved field radiotherapy was done in 69%. Thirty-two patients had an event, 12 were in progressive disease, 19 relapsed, and 1 died. The 7 year event-free survival was 43 9%. Among 118 patients, 57 were alive and followed-up, 3 patients died, and 58 (49%) were LOF. Age distribution of the HD differs among region and ethnic groups. In developing countries, the peak incidence is usually in the group of 5–9 years [5]. In Turkish study, the median age was 8 year [6]. Our male to female ratio was similar to that in India [3]. In western countries, NS subtype is the most common subtype [7]. In Iran and Turkey, the majority of tumors were classified as MC [5,6]. Combined-modality treatment approach has yielded excellent results, with long-term disease-free survival of 85–100% in patients with early-stage disease [8]. Many problems in managing HL have been identified and we are proposing several strategies to enhance HL management in our unit, the use of hybrid protocol according to drugs available in Morocco; a dedicated team for HL to insure an accurate assessment; and a social program to address social and financial issues. Laila Hessissen, MD* N. Oulhiane, MD M. ElKhorassani, MD M.N. Nachef, MD M. Khattab, MD F. Msefer Alaoui, MD Pediatric Hematology and Oncology Unit Children’s Hospital of Rabat Rabat, Morocco

Informational Support in Pediatric Oncology: Review of the Challenges Among Arab Families

Childhood cancer and its invasive treatment is a distressing life experience for the child and his family. Providing informational support is an essential part of community care, and defining parent’s burden is an important part of this goal. However, providing such information can be particularly challenging in Arab countries where beliefs, traditions, religion, and socioeconomic factors influence parents’ needs and their priorities of needs. This article presents a review of these specificities among Arab families. Implications of health-care providers are also discussed.

Cytogenetic Profile of Moroccan Pediatric Acute Lymphoblastic Leukemia: Analysis of 155 Cases With a Review of the Literature

&NA; The purpose of the present study was to define the frequency of chromosomal abnormalities in 155 Moroccan patients with acute lymphoblastic leukemia referred to the BIOLAB Laboratory from the Children’s Hospital of Rabat and compare our findings with those from reported studies. We identified chromosomal aberrations in 66% of the cases, of which 70% revealed recurrent abnormalities with high prognostic value that correlated with the reported data and their lineage. Background: Acute lymphoblastic leukemia (ALL) is the most common malignancy in children, with a peak incidence at 2 to 3 years of age and accounting for almost 30% of all cancers in this age group. It is well established that the identification of cytogenetic abnormalities is highly relevant for the prognosis of and therapeutic decisions in ALL. The purpose of the present study was to define the frequency of recurrent chromosomal abnormalities of ALL in Moroccan patients referred exclusively to the BIOLAB Laboratory of the Childrens Hospital of Rabat during a 4‐year period and compare our findings to the reported data. Patients and Methods: We performed conventional karyotyping of 155 ALL cases, with a successful cell culture rate of 94%. Results: We identified chromosomal abnormalities in 66% of the total studied cases, of which 70% revealed important recurrent abnormalities with high prognostic value, such as hyperdiploidy, hypodiploidy, t(9;22), t(8;14), t(1;19), and MLL rearrangements. In total agreement with the reported data, most of the patients (56%) in the present study were aged 1 to 5 years, with a male predominance, and B‐ALL was the most common blast phenotype (85%). Conclusion: The frequency of most chromosomal rearrangements successfully identified in our study and their lineage correlated with those reported in the published data.

An Intensive Induction Protocol for High Risk Neuroblastoma in Morocco

Abstract 72Background:Neuroblastoma is the most common extracranial solid tumor of childhood, accounting for 10% of childhood cancers in high-income countries (HIC), with an unknown incidence in most low- and middle-income countries (LMIC). A multidisciplinary approach to the treatment of high-risk (HR) neuroblastoma consisting of a combination of chemotherapy, surgery, radiation and immunotherapy, has lead to improvements in survival in HICs, approaching 40-50%. Morocco, a LMIC, has historically had a survival rate for HR neuroblastoma of 10-15% at three years, with almost no survival at five years from diagnosis, due to a combination of limited availability of accurate diagnosis, staging, and risk stratification, as well as lack of some of the necessary treatment modalities and high abandonment rates. The International Society for Pediatric Oncology (SIOP) Pediatric Oncology in Developing Countries (PODC) committee developed adapted risk stratification and treatment guidelines using locally available ch...

SIOP-PODC adapted risk stratification and treatment guidelines: Recommendations for neuroblastoma in low- and middle-income settings: SIOP-PODC Adapted Risk Stratification and Treatment

Neuroblastoma is the most common extracranial solid tumor in childhood in high‐income countries (HIC), where consistent treatment approaches based on clinical and tumor biological risk stratification have steadily improved outcomes. However, in low‐ and middle‐ income countries (LMIC), suboptimal diagnosis, risk stratification, and treatment may occur due to limited resources and unavailable infrastructure. The clinical practice guidelines outlined in this manuscript are based on current published evidence and expert opinions. Standard risk stratification and treatment explicitly adapted to graduated resource settings can improve outcomes for children with neuroblastoma by reducing preventable toxic death and relapse. Pediatr Blood Cancer 2015;62:1305–1316.