Burkitt lymphoma

The global pediatric oncology clinical research landscape, particularly in Central and South America, Africa, and Asia, which bear the highest burden of global childhood cancer cases, is less characterized in the literature. Review of how existing pediatric cancer clinical trial groups internationally have been formed and how their research goals have been pursued is critical for building global collaborative research and data-sharing efforts, in line with the WHO Global Initiative for Childhood Cancer.A narrative literature review of collaborative groups performing pediatric cancer clinical research in each continent was conducted. An inventory of research groups was assembled and reviewed by current pediatric cancer regional and continental leaders. Each group was narratively described with identification of common structural and research themes among consortia.There is wide variability in the structure, history, and goals of pediatric cancer clinical trial collaborative groups internationally. Several continental regions have longstanding endogenously-formed clinical trial groups that have developed and published numerous adapted treatment regimens to improve outcomes, whereas other regions have consortia focused on developing foundational database registry infrastructure supported by large multinational organizations or twinning relationships.There cannot be a one-size-fits-all approach to increasing collaboration between international pediatric cancer clinical trial groups, as this requires a nuanced understanding of local stakeholders and resources necessary to form partnerships. Needs assessments, performed either by local consortia or in conjunction with international partners, have generated productive clinical trial infrastructure. To achieve the goals of the Global Initiative for Childhood Cancer, global partnerships must be sufficiently granular to account for the distinct needs of each collaborating group and should incorporate grassroots approaches, robust twinning relationships, and implementation science. 

https://ascopubs.org/doi/pdfdirect/10.1200/GO.21.00266

Mapping Pediatric Oncology Clinical Trial Collaborative Groups on the Global Stage

Background: The paediatric oncology multidisciplinary team at the University of Cape Town (UCT) developed a research-ready data set.Aim: This study aimed to describe the early results detailing the epidemiological profile of childhood cancer patients and evaluated factors associated with presentation and outcome.Setting: The UCT paediatric oncology platform at the Red Cross War Memorial Children’s Hospital (RCWMCH) and Groote Schuur Hospital (GSH).Methods: A REDCap database was developed with a Cancer Association of South Africa (CANSA) grant. A database administrator consented all new patients and recorded demographic and social information.Results: There were 212 children consented from 2019 to 2021: 109 girls and 103 boys. The age range was from 1 day to 15.98 years, with a median of 5.18 years. Only 32 (15%) of these families had medical insurance, 34 (16%) lived in informal housing and 25 (12%) did not have access to piped water. Seventy-four families (35%) reported a relative with cancer, including seven first degree relatives. With a median follow-up of 12.4 months, the estimated 2-year overall survival (OS) and event-free survival (EFS) was 77% and 72%, respectively. Overall survival was significantly different (p = 0.013) by disease group, varying from 100% for Wilms tumour and germ cell tumours to 52% for rhabdomyosarcoma. Most patients with solid tumours (72%) had advanced disease at diagnosis. Outcomes were poorer for children living in informal housing and without piped water.Conclusion: A real-time database can provide a research-ready data set for interrogating cohort-specific factors impacting childhood cancer outcomes. 

/pdf/the-university-of-cape-towns-paediatric-cancer-database-iezc9o2t.pdf

The University of Cape Town’s paediatric cancer database: Results from the first years (2019–2021)

PURPOSE Over 400,000 children are diagnosed with cancer around the world each year, with over 80% of these children residing in low- and middle-income countries. This study aims to summarize the epidemiology and care patterns of newly diagnosed childhood cancer patients in Northern Tanzania. METHODS Data from all children and adolescents (age 0-19 years) with newly diagnosed cancers were collected from the Kilimanjaro Cancer Registry located at the Kilimanjaro Christian Medical Centre. Descriptive and inferential analyses were used to compare the demographic and clinical characteristics of the participants over time, stage, and status at last contact. Statistical significance was set at P &lt; .05. Secondary descriptive analysis was conducted on a subset sample with available staging data. RESULTS A total of 417 patients were diagnosed with cancer between 2016 and 2021. There was an increase in the rate of patients with newly diagnosed pediatric cancer each year, particularly among children under age 5 years and 10 years. Leukemias and lymphomas were the leading diagnoses and accounted for 183 (43.8%) of all patients. Over 75% of patients were diagnosed at stage III or above. From a subset analysis of patients with available staging data (n = 101), chemotherapy was the most common treatment (87.1%), compared with radiotherapy and surgery. CONCLUSION There is a significant burden of children with cancer in Tanzania. Our study fills crucial gaps in the literature related to the large burden of disease and survival for children with cancer in the Kilimanjaro region. Furthermore, our results can be used to understand the regional needs and guide research and strategic interventions to improve childhood cancer survival in Northern Tanzania. 

https://ascopubs.org/doi/pdfdirect/10.1200/GO.22.00263?role=tab

Childhood and Adolescent Cancer Care at a Tertiary Hospital in Northern Tanzania: A Retrospective Study

The lack of accurate population-based information on childhood cancer stage and survival in low-income countries is a barrier to improving childhood cancer outcomes. In our study, data from three population-based registries in sub-Saharan Africa (Abidjan, Harare and Kampala) were examined for children aged under 15. We assessed the feasibility of assigning stage at diagnosis according to Tier 1 of the Toronto Childhood Cancer Stage Guidelines for patients with non-Hodgkin lymphoma [including Burkitt lymphoma (BL)], retinoblastoma and Wilms' tumour. Patients were actively followed-up, allowing calculation of 3-year relative survival by cancer type and registry. Stage-specific observed survival was estimated. The cohort comprised 381 children, of whom half (n = 192, 50%) died from any cause within 3 years of diagnosis. Three-year relative survival varied by malignancy and location and ranged from 17% [95% confidence interval (CI) = 6%-33%] for BL in Harare to 57% (95% CI = 31%-76%) for retinoblastoma in Kampala. Stage was assigned for 83% of patients (n = 317 of 381), with over half having metastatic or advanced disease at diagnosis (n = 166, 52%). Stage was a strong predictor of survival for each malignancy; for example, 3-year observed survival was 88% (95% CI = 68%-96%) and 13% (4%-29%) for localised and advanced BL, respectively (P <.001). These are the first data on stage distribution and stage-specific survival for childhood cancers in Africa. They demonstrate the feasibility of the Toronto Stage Guidelines in a low-resource setting and highlight the value of population-based cancer registries in aiding our understanding of the poor outcomes experienced by this population.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/ijc.33468

Franck Gnahatin

Papers

Stage at diagnosis and survival by stage for the leading childhood cancers in three populations of sub-Saharan Africa