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Highlights from the 13th African Continental Meeting of the International Society of Paediatric Oncology (SIOP), 6–9 March 2019, Cairo, Egypt

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      Abstract

      The 13th African continental meeting of the international society of paediatric oncology, held on 6–9 March 2019 in Cairo, was organised in collaboration with the Children Cancer Hospital (57357) in Egypt and the global parents’ organisation (Childhood Cancer International) and supported by a large international faculty. With 629 delegates from 37 countries (24 African), this was the largest forum of healthcare professionals focused on children and young people with cancer in Africa to showcase advances and discuss further improvements. Three targeted workshops, on nursing care, pharmacy and nutrition, attracted large numbers and catalysed new collaborative initiatives in supportive care studies, extended roles for pharmacists in quality control and care delivery and addressed malnutrition concurrently with cancer treatment. The Collaborative Wilms Tumour Africa Project, open in seven sub-Saharan countries, and the trials in Burkitt’s lymphoma reported encouraging outcomes with further initiatives in supportive care (the supportive care for children with cancer in Africa project). While acknowledging deficits in radiotherapy provision, available in only 23 of 52 African countries, centres with facilities reported their technical advances that benefit patients. Of great importance for children with brain tumours, who are underdiagnosed in Africa, was the first announcement of African paediatric neuro-oncology society, whose 63 current members aim to tackle the shortage of neurosurgeons through training fellowships, workshops and a dedicated conference. The congress provided the opportunity to discuss how African countries will work with the WHO global initiative aiming to improve childhood cancer survival to 60% in all countries by 2030. This conference report is dedicated to the three Kenyan delegates who died tragically on the Ethiopian Airlines flight ET302 on their way home, full of new ideas and pride in what they had achieved so far. All those who heard their presentations are determined to continue their excellent work to improve cancer care for children in Africa.

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      To review the impact of collaborative studies on advances in the biology and treatment of acute lymphoblastic leukemia (ALL) in children and adolescents.
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        Treatment reduction for children and young adults with low-risk acute lymphoblastic leukaemia defined by minimal residual disease (UKALL 2003): a randomised controlled trial.

        Minimal residual disease (MRD) is the most sensitive and specific predictor of relapse risk in children with acute lymphoblastic leukaemia (ALL) during remission. We assessed whether treatment intensity could be adjusted for children and young adults according to MRD risk stratification. Between Oct 1, 2003 and June 30, 2011, consecutive children and young adults (aged 1-25 years) with ALL from the UK and Ireland were recruited. Eligible patients were categorised into clinical standard, intermediate, and high risk groups on the basis of a combination of National Cancer Institute (NCI) criteria, cytogenetics, and early response to induction therapy, which was assessed by bone marrow blast counts taken at days 8 (NCI high-risk patients) and 15 (NCI standard-risk patients) after induction began. Clinical standard-risk and intermediate-risk patients were assessed for MRD. Those classified as MRD low risk (undetectable MRD at the end of induction [day 29] or detectable MRD at day 29 that became undetectable by week 11) were randomly assigned to receive one or two delayed intensification courses. Patients had received induction, consolidation, and interim maintenance therapy before they began delayed intensification. Delayed intensification consisted of pegylated asparaginase on day 4; vincristine, dexamethasone (alternate weeks), and doxorubicin for 3 weeks; and 4 weeks of cyclophosphamide and cytarabine. Computer randomisation was done with stratification by MRD result and balancing for sex, age, and white blood cell count at diagnosis by method of minimisation. Patients, clinicians, and data analysts were not masked to treatment allocation. The primary outcome was event-free survival (EFS), which was defined as time to relapse, secondary tumour, or death. Our aim was to rule out a 7% reduction in EFS in the group given one delayed intensification course relative to that given two delayed intensification courses. Analyses were by intention to treat. This trial is registered, number ISRCTN07355119. Of 3207 patients registered in the trial overall, 521 MRD low-risk patients were randomly assigned to receive one (n=260) or two (n=261) delayed intensification courses. Median follow-up of these patients was 57 months (IQR 42-72). We recorded no significant difference in EFS between the group given one delayed intensification (94·4% at 5 years, 95% CI 91·1-97·7) and that given two delayed intensifications (95·5%, 92·8-98·2; unadjusted odds ratio 1·00, 95% CI 0·43-2·31; two-sided p=0·99). The difference in 5-year EFS between the two groups was 1·1% (95% CI -5·6 to 2·5). 11 patients (actuarial relapse at 5 years 5·6%, 95% CI 2·3-8·9) given one delayed intensification and six (2·4%, 0·2-4·6) given two delayed intensifications relapsed (p=0·23). Three patients (1·2%, 0-2·6) given two delayed intensifications died of treatment-related causes compared with none in the group given one delayed intensification (p=0·08). We recorded no significant difference between groups for serious adverse events and grade 3 or 4 toxic effects; however, the second delayed intensification course was associated with one (<1%) treatment-related death, and 74 episodes of grade 3 or 4 toxic effects in 45 patients (17%). Treatment reduction is feasible for children and young adults with ALL who are predicted to have a low risk of relapse on the basis of rapid clearance of MRD by the end of induction therapy. Medical Research Council and Leukaemia and Lymphoma Research. Copyright © 2013 Elsevier Ltd. All rights reserved.
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          Postinduction dexamethasone and individualized dosing of Escherichia Coli L-asparaginase each improve outcome of children and adolescents with newly diagnosed acute lymphoblastic leukemia: results from a randomized study--Dana-Farber Cancer Institute ALL Consortium Protocol 00-01.

          We assessed the toxicity and efficacy of dexamethasone and a novel dosing method of Escherichia coli L-asparaginase (EC-Asnase) in children and adolescents with newly diagnosed acute lymphoblastic leukemia (ALL). Patients achieving complete remission (CR) on Dana-Farber Cancer Institute ALL Consortium Protocol 00-01 were eligible for random assignment to 1) dexamethasone or prednisone, administered as 5-day pulses, every 3 weeks, and 2) weekly EC-Asnase, administered as a 25,000 IU/m(2) fixed dose (FD) or individualized dose (ID) starting at 12,500-IU/m(2), adjusted every 3 weeks based on nadir serum asparaginase activity (NSAA) determinations. Between 2000 and 2004, 492 evaluable patients (ages 1 to 18 years) enrolled; 473 patients (96%) achieved CR. Four hundred eight patients (86%) participated in the corticosteroid randomization and 384 patients (81%) in the EC-Asnase randomization. With 4.9 years of median follow-up, dexamethasone was associated with superior 5-year event-free survival (EFS; 90% v 81% for prednisone; P = .01) but higher rates of infection (P = .03) and, in older children, higher cumulative incidence of osteonecrosis (P = .02) and fracture (P = .06). ID EC-Asnase had superior 5-year EFS (90% v 82% for FD; P = .04), but did not reduce the frequency of asparaginase-related toxicity. Multivariable analysis identified both dexamethasone and ID EC-Asnase as independent predictors of favorable EFS. There was no overall difference in skeletal toxicity by corticosteroid type; dexamethasone was associated with more infections and, in older children, increased incidence of osteonecrosis and fracture. There was no difference in asparaginase-related toxicity by EC-Asnase dosing method. Dexamethasone and ID EC-Asnase were each associated with superior EFS. Monitoring NSAA during treatment with EC-Asnase may be an effective strategy to improve outcome in pediatric ALL.
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            Author and article information

            Affiliations
            [1 ]Professor of Paediatric Oncology, Faculty of Medicine, Zagazig University, Children’s Cancer Hospital Egypt 57357, Cairo 11617, Egypt
            [2 ]Manager, Cameroon Baptist Convention Health Services Childhood Cancer Programme, Cameroon University of Stellenbosch, Stellenbosch 7602, South Africa
            [3 ]Professor of neurosurgery, Faculty of Medicine, Cairo University, Kasr El Aini, Cairo, and Head of Neurosurgery, Children’s Cancer Hospital Egypt 57357, Cairo 11617, Egypt
            [4 ]Nursing officer, Uganda Cancer Institute, Kampala, PO Box 3935 Uganda
            [5 ]Dean, Faculty of Nursing, Helwan University, Modern University for Technology and Information (MTI), Cairo, Egypt
            [6 ]Princess Màxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
            [7 ]Paediatric Department, College of Medicine/Queen Elizabeth Central Hospital, Blantyre, Malawi
            [8 ]The University of Tennessee Health Science Center, Memphis, TN 38163 USA
            [9 ]CLCC G Groupe Franco-Africain d’Oncologie Pédiatrique (GFAOP), Institut Gustave Roussy, France and GFAOP, 94800 Villejuif, France
            [10 ]Chief dietician, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town 7530, South Africa
            [11 ]Associate Professor for Global Integrative Medicine, Director, Integrative Therapies Program, Columbia University Medical Center, USA
            [12 ]Professor of Radiation Oncology, National Cancer Institute; Chair, Radiation Oncology Department, Children’s Cancer Hospital Egypt 57357, Cairo, Egypt
            [13 ]Professor of Pediatric Surgery, Alexandria University, Alexandria 21568, Egypt
            [14 ]Chairman, Clinical Oncology Department, Aswan University and Consultant, Children’s Cancer Hospital Egypt 57357, Cairo, Egypt
            [15 ]Director, Department of Pharmaceutical Services, Children’s Cancer Hospital Egypt 57357, Cairo, Egypt
            [16 ]President, International Society of Paediatric Oncology (SIOP), Professor of Neuro-oncology, Sick Children’s Hospital, Toronto ON M5G 1X8, Canada
            [17 ]SIOP President-elect, Professor of Paediatric Oncology, UCL Great Ormond Street Institute of Child Health, University College London, London WC1E 6BT, UK
            [18 ]SIOP Africa Continental President, Professor of Paediatrics, Pediatric Haematology and Oncology Center, University Mohamed V Rabat, Rabat BP.8007.UN, Morocco
            Author notes
            Correspondence to: Professor Elhamy Rifky Khalek elhamyrifky@ 123456yahoo.com
            Journal
            Ecancermedicalscience
            Ecancermedicalscience
            ecancermedicalscience
            ecancermedicalscience
            Cancer Intelligence
            1754-6605
            2019
            28 May 2019
            : 13
            6592710
            10.3332/ecancer.2019.932
            can-13-932
            © the authors; licensee ecancermedicalscience.

            This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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