Burkitt's lymphoma

Burkitt's lymphoma is a highly aggressive B-cell non-Hodgkin lymphoma and is the fastest growing human tumour. The disease is associated with Epstein-Barr virus and was one of the first tumours shown to have a chromosomal translocation that activates an oncogene (c-MYC). Burkitt's lymphoma is the most common childhood cancer in areas where malaria is holoendemic. The incidence is very high in immunosuppressed patients in non-endemic areas, especially when associated with HIV infection. Outcome with intensive chemotherapy has improved and is now excellent in children, but the prognosis is poor in elderly adults. The success of intensive treatment relies on good supportive care. The therapy offered in oncology units in low-income countries is not as aggressive as in centres in high-income countries and outcomes are less successful. Adjuvant monoclonal antibody therapy with rituximab shows promise for improved outcomes and reduced toxic effects in the future

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. © 2015 The Authors. Pediatric Blood & Cancer, published by Wiley Periodicals, Inc

Data collection in the Collaborative Wilms Tumour Africa Project

CITATION: Israels, T., Molyneux, E. & Collaborative Wilms Tumour Africa team. 2018. Data collection in the Collaborative Wilms Tumour Africa Project. Pediatric Hematology Oncology Journal, 3(4):109-114, doi:10.1016/j.phoj.2018.09.001.The original publication is available at https://www.sciencedirect.com/science/article/pii/ENGLISH ABSTRACT: No abstract availablehttps://www.sciencedirect.com/science/article/pii/S2468124518300445?via%3Dihub#!Publisher's versio

Strategies to improve care for children with cancer in Sub-Saharan Africa

Great progress has been made in the care of children with cancer in recent decades. Worldwide, more than 80% of children with cancer live in resource-limited countries where access to care is poor. Sub-Saharan Africa is the world's poorest region. Child mortality is high, caused by largely preventable and treatable conditions. Paediatric cancer accounts for only a small fraction of deaths and understandably receives little attention from local policy makers or global health agencies. The survival of children with cancer is very poor. Challenges to improving survival include advanced-stage disease at presentation, failure to start or complete treatment (abandonment), inadequate hospital infrastructure and medications, lack of trained health care providers, lack of cancer registration and follow-up and lack of treatment guidelines adapted to local medical facilities. We propose a stepwise approach that integrates paediatric cancer treatment with existing general paediatric care. Priority is given to interventions (improvement of supportive care, diagnostic facilities) that also improve general paediatric care. Minimal requirements for diagnostic procedures include complete blood counts, HIV and malaria tests, blood cultures, histopathology and simple imaging (X-ray and ultrasonography). Feasible interventions include adequate palliative care, curative treatment for Burkitt lymphoma and Wilms tumour and symptomatic treatment for Kaposi sarcom

Nutritional status at admission of children with cancer in Malawi

Background. Malnutrition at diagnosis is found in 10-50% of children with cancer in industrialized countries. In developing countries a large proportion of the normal paediatric population is undernourished and children with cancer often present late with advanced disease. Therefore it would be expected that many children with cancer are malnourished at admission. Malnutrition is associated with more severe chemotherapy toxicity and infectious complications. Methods. All new paediatric oncology patients admitted in the Queen Elizabeth Central Hospital, Blantyre, Malawi between 1, January 2007 and 1, January 2008 were included. We documented age, clinical diagnosis, HIV status, weight, height, mid-upper-arm-circumference (MUAC) and triceps skinfold (TSF), and calculated arm muscle area (AMA). Nutritional data were compared with the 1978 NCHS growth curves. Results. 01 128 children, 70 (55.1% had an AMA for age <5th percentile and 76 (59.3%) had a TSF and MUAC below the 5th percentile, both parameters indicating acute malnutrition. Fifty seven patient (44.5%) had a height for age <-2 SD (indicative of stunting), and 22 patients (17.2%) had a weight for height (WFH) <-2 SD. Conclusion. Arm anthropometry shows that more than half of Malawian children with cancer are severely acutely malnourished at diagnosis. WFH, in children with large tumour masses, is less sensitive than arm anthropometry in detecting acute malnulation. Forty-five percent of paediatric oncology patients in Malawi are stunted, making interpretation of weight for age (WFA) very difficul

Improving Care for Children With Cancer in Low- and Middle-Income Countries--a SIOP PODC Initiative

The Paediatric Oncology in Developing Countries (PODC) committee of International Society of Paediatric Oncology (SIOP) has 10 working groups that provide a forum for individuals to engage, network, and implement improvements in the care of children with cancer in low- and middle-income countries. The development of adapted guidelines (medulloblastoma, retinoblastoma, Wilms tumor, neuroblastoma, retinoblastoma, Burkitt lymphoma, supportive care), advocacy and awareness (on hospital detention and essential drugs), education and training, and global mapping (nutritional practice, abandonment rates, and twinning collaborations) have been the initial areas of focus, and the impact of some of these activities is evident, for example, in the SIOP Africa PODC Collaborative Wilms tumor project

The efficacy and toxicity of SIOP preoperative chemotherapy in Malawian children with a Wilms tumour

Background In Malawi, preoperative chemotherapy for Wilms tumour is a logical strategy, but detailed information on toxicity and efficacy in such a resource limited setting has been unavailable. Procedure Patients diagnosed with a unilateral Wilms tumour received preoperative chemotherapya two-drug 4-week regimen for localized disease and 6 weeks of a three-drug regimen for metastatic disease. Estimated maximum tumour diameter, decrease in tumour size, resectability, stage distribution and haematological toxicity during therapy were documented. Results At diagnosis, 28% of 72 patients had an estimated maximum tumour diameter of more than 25?cm; 29% of patients had metastases. Eight children (11%) died during preoperative chemotherapy. More than half (59%) of the patients developed moderate neutropenia (neutrophils <1.0?x?109/L; CTC grade 3) and 27% severe neutropenia (CTC grade 4 neutrophils <0.5?x?10.9/L). Grade 4 neutropenia occurred significantly more frequently in children receiving the three-drug regimen compared to the two-drug regimen; 50% (10/20) versus 15% (6/40) (P?=?0.004). Fifty-seven percent of all patients had CTC grade 4 anaemia (Hb? <?6.5?g/dL) during treatment. Most tumours (92%, 56/61) showed a response to chemotherapy but 14% (8/58) remained unresectable. Conclusion Preoperative chemotherapy for Wilms tumour causes considerable haematological toxicity and treatment-related mortality in malnourished Malawian children. A significant number of children have unresectable disease despite preoperative chemotherapy. To reduce treatment related mortality, consideration should be given to starting treatment with reduced doses in acutely malnourished patients. Pediatr Blood Cancer 2012;59:636641. (c) 2012 Wiley Periodicals, In

Management of Children With a Wilms Tumor in Malawi, Sub-Saharan Africa

Wilms tumor has a survival rate of 85% to 90% in well-resourced countries. Malawi is a country in Sub-Saharan Africa with very limited resources. We evaluated the outcome of a treatment guideline including preoperative chemotherapy, supportive care, and strategies to enable parents to complete treatment. Between 2006 and 2011, 95 patients were initially diagnosed with a Wilms tumor; 11 were later excluded due to misdiagnosis. In 31% of patients, metastases were detected at presentation. Treatment outcomes in 8 patients with bilateral tumors and 3 patients who were referred after nephrectomy are analyzed separately. Treatment failed in 51% of 73 remaining patients. Reasons for failure were: 1) incomplete treatment (7%); 2) treatment-related deaths (15%); and 3) disease-related deaths (28%) with 11% unresectable tumors or metastases after preoperative chemotherapy and 17% relapse of disease. Projected survival is 46%. Challenges remain to improve survival for children with Wilms tumor in Malawi. Earlier diagnosis would reduce disease-related deaths as numbers of unresectable disease and relapse are high. Effective strategies, including social support, to enable parents to complete treatment need to be continued. Improved supportive care and nutritional support and possibly less intense preoperative chemotherapy are needed to reduce treatment-related death