Acute leukemia in children: A review of the current Indian data

Ramandeep Singh Arora; Brijesh Arora

doi:10.4103/2278-330X.187591

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Review Article

05 (

); 155-160

doi:

10.4103/2278-330X.187591

Acute leukemia in children: A review of the current Indian data

Ramandeep Singh Arora^1,, Brijesh Arora²

1 Department of Medical Oncology, Max Super Speciality Hospital, New Delhi

2 Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra

*Corresponding author: Dr. Ramandeep Singh Arora. childhoodcancer@gmail.com

Published: 2020-12-28

MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

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Abstract

Acute leukemias are the most common diagnostic group of childhood cancer. This review summarizes the published literature on reported current outcomes of childhood acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) from India. Overall survival in ALL ranged from 45% to 81% (commonly >60%) and event-free survival ranged from 41% to 70% (commonly >50%). Outcome data for AML was patchy with varying duration of follow-up, but it can be inferred that 50-80% of treated patients had experienced an event (toxic death, refractory disease or relapse). It is imperative that going forward focus should be on collaborative efforts, which promote treatment of patients on risk-stratified adapted protocols based on local infrastructure, improvement in supportive care and encourage prospective multi-center clinical trials.

Keywords

References

Stiller CA, Parkin DM. Geographic and ethnic variations in the incidence of childhood cancer. Br Med Bull 1996;52:682-703.
Arora RS, Eden TO, Kapoor G. Epidemiology of childhood cancer in India. Indian J Cancer 2009;46:264-73.
Pui CH, Yang JJ, Hunger SP, Pieters R, Schrappe M, Biondi A, et al. Childhood acute lymphoblastic leukemia: Progress through collaboration. J Clin Oncol 2015;33:2938-48.
Zwaan CM, Kolb EA, Reinhardt D, Abrahamsson J, Adachi S, Aplenc R, et al. Collaborative efforts driving progress in pediatric acute myeloid leukemia. J Clin Oncol 2015;33:2949-62.
Magrath I, Shanta V, Advani S, Adde M, Arya LS, Banavali S, et al. Treatment of acute lymphoblastic leukaemia in countries with limited resources; lessons from use of a single protocol in India over a twenty year period [corrected]. Eur J Cancer 2005;41:1570-83. [Erratum in: Eur J Cancer 2007;43:632. Raina, V [added].
Kulkarni KP, Arora RS, Marwaha RK. Survival outcome of childhood acute lymphoblastic leukemia in India: A resource-limited perspective of more than 40 years. J Pediatr Hematol Oncol 2011;33:475-9.
Swaminathan R, Rama R, Shanta V. Childhood cancers in Chennai, India, 1990-2001: Incidence and survival. Int J Cancer 2008;122:2607-11.
Bajel A, George B, Mathews V, Viswabandya A, Kavitha ML, Srivastava A, et al. Treatment of children with acute lymphoblastic leukemia in India using a BFM protocol. Pediatr Blood Cancer 2008;51:621-5.
Kulkarni KP, Marwaha RK, Trehan A, Bansal D. Survival outcome in childhood ALL: Experience from a tertiary care centre in North India. Pediatr Blood Cancer 2009;53:168-73.
Arya LS, Kotikanyadanam SP, Bhargava M, Saxena R, Sazawal S, Bakhshi S, et al. Pattern of relapse in childhood ALL: Challenges and lessons from a uniform treatment protocol. J Pediatr Hematol Oncol 2010;32:370-5.
Yadav SP, Ramzan M, Lall M, Sachdeva A. Childhood acute lymphoblastic leukemia outcome in India: Progress on all fronts. J Pediatr Hematol Oncol 2012;34:324.
Mukhopadhyay A, Gangopadhyay S, Dasgupta S, Paul S, Mukhopadhyay S, Ray UK. Surveillance and expected outcome of acute lymphoblastic leukemia in children and adolescents: An experience from Eastern India. Indian J Med Paediatr Oncol 2013;34:280-2.
Gupta A, Kapoor G, Jain S, Bajpai R. Absolute lymphocyte count recovery independently predicts outcome in childhood acute lymphoblastic leukemia: Experience from a tertiary care cancer center of a developing country. J Pediatr Hematol Oncol 2015;37:e143-9.
Radhakrishnan V, Gupta S, Ganesan P, Rajendranath R, Ganesan TS, Rajalekshmy KR, et al. Acute lymphoblastic leukemia: A single center experience with Berlin, Frankfurt, and Munster-95 protocol. Indian J Med Paediatr Oncol 2015;36:261-4.
Gupta N, Seth T, Mishra P, Mahapatra M, Rathi S, Kapoor R, et al. Treatment of acute myeloid leukemia in children: Experience from a tertiary care hematology centre in India. Indian J Pediatr 2011;78:1211-5.
Yadav SP, Ramzan M, Lall M, Sachdeva A. Pediatric acute myeloid leukemia: Final frontier for pediatric oncologists in developing world. Pediatr Hematol Oncol 2011;28:647-8.
Philip C, George B, Ganapule A, Korula A, Jain P, Alex AA, et al. Acute myeloid leukaemia: Challenges and real world data from India. Br J Haematol 2015;170:110-7.
Bahl A, Sharma A, Raina V, Kumar L, Bakhshi S, Gupta R, et al. Long-term outcomes for patients with acute myeloid leukemia: A single-center experience from AIIMS, India. Asia Pac J Clin Oncol 2015;11:242-52.
Radhakrishnan V, Thampy C, Ganesan P, Rajendranath R, Ganesan TS, Rajalekshmy KR, et al. Acute myeloid leukemia in children: Experience from tertiary cancer centre in India. Indian J Hematol Blood Transfus 2015. DOI: 10.1007/s12288-015-0591-5.
Kulkarni KP, Marwaha RK. Childhood acute myeloid leukemia: An Indian perspective. Pediatr Hematol Oncol 2011;28:257-68.
Arora B, Kanwar V. Childhood cancers in India: Burden, barriers, and breakthroughs. Indian J Cancer 2009;46:257-9.
Howard SC, Pedrosa M, Lins M, Pedrosa A, Pui CH, Ribeiro RC, et al. Establishment of a pediatric oncology program and outcomes of childhood acute lymphoblastic leukemia in a resource-poor area. JAMA 2004;291:2471-5.
Abboud MR, Ghanem K, Muwakkit S. Acute lymphoblastic leukemia in low and middle-income countries: Disease characteristics and treatment results. Curr Opin Oncol 2014;26:650-5.
Arora RS, Pizer B, Eden T. Understanding refusal and abandonment in the treatment of childhood cancer. Indian Pediatr 2010;47:1005-10.
Jatia S, Aggarwal P, Jayalakshmi KK, Arora B, Chinnaswamy G, Vora T, et al. Predictors of treatment refusal and abandonment (TR and A) and impact of personalized psycho-socioeconomic support in childhood cancer in a tertiary cancer centre in India. Pediatr Blood Cancer 2012;59:989.
Hunger SP, Sung L, Howard SC. Treatment strategies and regimens of graduated intensity for childhood acute lymphoblastic leukemia in low-income countries: A proposal. Pediatr Blood Cancer 2009;52:559-65.
Yeoh AE, Tan D, Li CK, Hori H, Tse E, Pui CH; Asian Oncology Summit 2013. Management of adult and paediatric acute lymphoblastic leukaemia in Asia: Resource-stratified guidelines from the Asian Oncology Summit 2013. Lancet Oncol 2013;14:e508-23.
Banavali SD, Biswas G, Nair CN, Kurkure PA, Saikia TK, Parikh PM. PRET: An effective oral protocol for out-patient therapy in patients with acute myeloid leukemia. Pediatr Blood Cancer 2004;43:355.
Jayabose S, Kumar V, Dhanabalan R, Rajan P, Rathnam K, Viswanathan TK. Low-dose rasburicase in hematologic malignancies. Indian J Pediatr 2015;82:458-61.
Sondhi V, Sharma A, Taneja M, Arora B, Banavali SD. L-asparginase administration reduces white blood cell count and prevents tumor lysis syndrome in children with hyperleukocytic acute lymphoblastic leukemia. Acta Haematol 2015;133:6-9.
Orgel E, Sposto R, Malvar J, Seibel NL, Ladas E, Gaynon PS, et al. Impact on survival and toxicity by duration of weight extremes during treatment for pediatric acute lymphoblastic leukemia: A report from the Children′s Oncology Group. J Clin Oncol 2014;32:1331-7.
Chen FW, Coyle L, Jones BE, Pattullo V. Entecavir versus lamivudine for hepatitis B prophylaxis in patients with haematological disease. Liver Int 2013;33:1203-10.
Jatia S, Arora B, Vora T, Banavali S, Rajadhyaksha S, Patil D, et al. Community platelet donor drives and establishment of a voluntary donor registry: A novel strategy to enhance treatment compliance & outcomes of childhood cancers in LMIC. Pediatr Blood Cancer 2015;62:S203.
Hudson MM, Meyer WH, Pui CH. Progress born from a legacy of collaboration. J Clin Oncol 2015;33:2935-7.
Bleyer WA. The U.S. pediatric cancer clinical trials programmes: International implications and the way forward. Eur J Cancer 1997;33:1439-47.
Stiller CA, Eatock EM. Patterns of care and survival for children with acute lymphoblastic leukaemia diagnosed between 1980 and 1994. Arch Dis Child 1999;81:202-8.
Ablett S, Pinkerton CR; United Kingdom Children′s Cancer Study Group (UKCCSG). Recruiting children into cancer trials - Role of the United Kingdom Children′s Cancer Study Group (UKCCSG). Br J Cancer 2003;88:1661-5.
Rajendranath R, Veeraiah S, Ramesh A, Sagar TG. Late effects of treatment in survivors of childhood cancer from a tertiary cancer center in South India. South Asian J Cancer 2014;3:60-5.

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[1] Stiller CA, Parkin DM. Geographic and ethnic variations in the incidence of childhood cancer. Br Med Bull 1996;52:682-703.

[2] Arora RS, Eden TO, Kapoor G. Epidemiology of childhood cancer in India. Indian J Cancer 2009;46:264-73.

[3] Pui CH, Yang JJ, Hunger SP, Pieters R, Schrappe M, Biondi A, et al. Childhood acute lymphoblastic leukemia: Progress through collaboration. J Clin Oncol 2015;33:2938-48.

[4] Zwaan CM, Kolb EA, Reinhardt D, Abrahamsson J, Adachi S, Aplenc R, et al. Collaborative efforts driving progress in pediatric acute myeloid leukemia. J Clin Oncol 2015;33:2949-62.

[5] Magrath I, Shanta V, Advani S, Adde M, Arya LS, Banavali S, et al. Treatment of acute lymphoblastic leukaemia in countries with limited resources; lessons from use of a single protocol in India over a twenty year period [corrected]. Eur J Cancer 2005;41:1570-83. [Erratum in: Eur J Cancer 2007;43:632. Raina, V [added].

[6] Kulkarni KP, Arora RS, Marwaha RK. Survival outcome of childhood acute lymphoblastic leukemia in India: A resource-limited perspective of more than 40 years. J Pediatr Hematol Oncol 2011;33:475-9.

[7] Swaminathan R, Rama R, Shanta V. Childhood cancers in Chennai, India, 1990-2001: Incidence and survival. Int J Cancer 2008;122:2607-11.

[8] Bajel A, George B, Mathews V, Viswabandya A, Kavitha ML, Srivastava A, et al. Treatment of children with acute lymphoblastic leukemia in India using a BFM protocol. Pediatr Blood Cancer 2008;51:621-5.

[9] Kulkarni KP, Marwaha RK, Trehan A, Bansal D. Survival outcome in childhood ALL: Experience from a tertiary care centre in North India. Pediatr Blood Cancer 2009;53:168-73.

[10] Arya LS, Kotikanyadanam SP, Bhargava M, Saxena R, Sazawal S, Bakhshi S, et al. Pattern of relapse in childhood ALL: Challenges and lessons from a uniform treatment protocol. J Pediatr Hematol Oncol 2010;32:370-5.

[11] Yadav SP, Ramzan M, Lall M, Sachdeva A. Childhood acute lymphoblastic leukemia outcome in India: Progress on all fronts. J Pediatr Hematol Oncol 2012;34:324.

[12] Mukhopadhyay A, Gangopadhyay S, Dasgupta S, Paul S, Mukhopadhyay S, Ray UK. Surveillance and expected outcome of acute lymphoblastic leukemia in children and adolescents: An experience from Eastern India. Indian J Med Paediatr Oncol 2013;34:280-2.

[13] Gupta A, Kapoor G, Jain S, Bajpai R. Absolute lymphocyte count recovery independently predicts outcome in childhood acute lymphoblastic leukemia: Experience from a tertiary care cancer center of a developing country. J Pediatr Hematol Oncol 2015;37:e143-9.

[14] Radhakrishnan V, Gupta S, Ganesan P, Rajendranath R, Ganesan TS, Rajalekshmy KR, et al. Acute lymphoblastic leukemia: A single center experience with Berlin, Frankfurt, and Munster-95 protocol. Indian J Med Paediatr Oncol 2015;36:261-4.

[15] Gupta N, Seth T, Mishra P, Mahapatra M, Rathi S, Kapoor R, et al. Treatment of acute myeloid leukemia in children: Experience from a tertiary care hematology centre in India. Indian J Pediatr 2011;78:1211-5.

[16] Yadav SP, Ramzan M, Lall M, Sachdeva A. Pediatric acute myeloid leukemia: Final frontier for pediatric oncologists in developing world. Pediatr Hematol Oncol 2011;28:647-8.

[17] Philip C, George B, Ganapule A, Korula A, Jain P, Alex AA, et al. Acute myeloid leukaemia: Challenges and real world data from India. Br J Haematol 2015;170:110-7.

[18] Bahl A, Sharma A, Raina V, Kumar L, Bakhshi S, Gupta R, et al. Long-term outcomes for patients with acute myeloid leukemia: A single-center experience from AIIMS, India. Asia Pac J Clin Oncol 2015;11:242-52.

[19] Radhakrishnan V, Thampy C, Ganesan P, Rajendranath R, Ganesan TS, Rajalekshmy KR, et al. Acute myeloid leukemia in children: Experience from tertiary cancer centre in India. Indian J Hematol Blood Transfus 2015. DOI: 10.1007/s12288-015-0591-5.

[20] Kulkarni KP, Marwaha RK. Childhood acute myeloid leukemia: An Indian perspective. Pediatr Hematol Oncol 2011;28:257-68.

[21] Arora B, Kanwar V. Childhood cancers in India: Burden, barriers, and breakthroughs. Indian J Cancer 2009;46:257-9.

[22] Howard SC, Pedrosa M, Lins M, Pedrosa A, Pui CH, Ribeiro RC, et al. Establishment of a pediatric oncology program and outcomes of childhood acute lymphoblastic leukemia in a resource-poor area. JAMA 2004;291:2471-5.

[23] Abboud MR, Ghanem K, Muwakkit S. Acute lymphoblastic leukemia in low and middle-income countries: Disease characteristics and treatment results. Curr Opin Oncol 2014;26:650-5.

[24] Arora RS, Pizer B, Eden T. Understanding refusal and abandonment in the treatment of childhood cancer. Indian Pediatr 2010;47:1005-10.

[25] Jatia S, Aggarwal P, Jayalakshmi KK, Arora B, Chinnaswamy G, Vora T, et al. Predictors of treatment refusal and abandonment (TR and A) and impact of personalized psycho-socioeconomic support in childhood cancer in a tertiary cancer centre in India. Pediatr Blood Cancer 2012;59:989.

[26] Hunger SP, Sung L, Howard SC. Treatment strategies and regimens of graduated intensity for childhood acute lymphoblastic leukemia in low-income countries: A proposal. Pediatr Blood Cancer 2009;52:559-65.

[27] Yeoh AE, Tan D, Li CK, Hori H, Tse E, Pui CH; Asian Oncology Summit 2013. Management of adult and paediatric acute lymphoblastic leukaemia in Asia: Resource-stratified guidelines from the Asian Oncology Summit 2013. Lancet Oncol 2013;14:e508-23.

[28] Banavali SD, Biswas G, Nair CN, Kurkure PA, Saikia TK, Parikh PM. PRET: An effective oral protocol for out-patient therapy in patients with acute myeloid leukemia. Pediatr Blood Cancer 2004;43:355.

[29] Jayabose S, Kumar V, Dhanabalan R, Rajan P, Rathnam K, Viswanathan TK. Low-dose rasburicase in hematologic malignancies. Indian J Pediatr 2015;82:458-61.

[30] Sondhi V, Sharma A, Taneja M, Arora B, Banavali SD. L-asparginase administration reduces white blood cell count and prevents tumor lysis syndrome in children with hyperleukocytic acute lymphoblastic leukemia. Acta Haematol 2015;133:6-9.

[31] Orgel E, Sposto R, Malvar J, Seibel NL, Ladas E, Gaynon PS, et al. Impact on survival and toxicity by duration of weight extremes during treatment for pediatric acute lymphoblastic leukemia: A report from the Children′s Oncology Group. J Clin Oncol 2014;32:1331-7.

[32] Chen FW, Coyle L, Jones BE, Pattullo V. Entecavir versus lamivudine for hepatitis B prophylaxis in patients with haematological disease. Liver Int 2013;33:1203-10.

[33] Jatia S, Arora B, Vora T, Banavali S, Rajadhyaksha S, Patil D, et al. Community platelet donor drives and establishment of a voluntary donor registry: A novel strategy to enhance treatment compliance & outcomes of childhood cancers in LMIC. Pediatr Blood Cancer 2015;62:S203.

[34] Hudson MM, Meyer WH, Pui CH. Progress born from a legacy of collaboration. J Clin Oncol 2015;33:2935-7.

[35] Bleyer WA. The U.S. pediatric cancer clinical trials programmes: International implications and the way forward. Eur J Cancer 1997;33:1439-47.

[36] Stiller CA, Eatock EM. Patterns of care and survival for children with acute lymphoblastic leukaemia diagnosed between 1980 and 1994. Arch Dis Child 1999;81:202-8.

[37] Ablett S, Pinkerton CR; United Kingdom Children′s Cancer Study Group (UKCCSG). Recruiting children into cancer trials - Role of the United Kingdom Children′s Cancer Study Group (UKCCSG). Br J Cancer 2003;88:1661-5.

[38] Rajendranath R, Veeraiah S, Ramesh A, Sagar TG. Late effects of treatment in survivors of childhood cancer from a tertiary cancer center in South India. South Asian J Cancer 2014;3:60-5.

Acute leukemia in children: A review of the current Indian data

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Abstract

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References

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