ALL-BFM 95 Treatment in Turkish Children with Acute Lymphoblastic Leukemia—Experience of a Single Center

Koçak, Ülker; Gürsel, Türkiz; Kaya, Zühre; Aral, Yusuf Ziya; Albayrak, Meryem; Keskin, Ebru Yılmaz; Belen, Burcu; Işık, Melek; Öner, Nergiz

doi:10.3109/08880018.2011.629859

Cited by 18 publications

(13 citation statements)

References 23 publications

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“…MTX is a key component of consolidation and maintenance treatment for childhood ALL [2]. However, some patients cannot tolerate HD-MTX, and in these cases the treatment can cause toxicity and discontinuation of chemotherapy, which may increase relapse risk in a small number of patients [5,8,23,24,25,29].…”

Section: Discussionmentioning

confidence: 99%

“…The metabolism of MTX is influenced by a number of polymorphisms in folate-related genes (FRGs) that encode the enzymes thymidylate synthase (TS), methionine synthase reductase ( MTRR ), and methylene tetrahydrofolate reductase ( MTHFR ) [1]. Currently, high-dose (HD) MTX is recommended for all patients with acute lymphoblastic leukemia (ALL) and for any patient with lymphoma or osteosarcoma [2,3,4]. However, there is no consensus on effective doses of HD-MTX in these patients.…”

Section: Introductionmentioning

confidence: 99%

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Influence of Folate-Related Gene Polymorphisms on High-Dose Methotrexate-Related Toxicity and Prognosis in Turkish Children with Acute Lymphoblastic Leukemia

Yazıcıoğlu¹,

Kaya

S³

et al. 2017

Tjh

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Objective:High-dose methotrexate (HD-MTX) is widely used in the consolidation phase of childhood acute lymphoblastic leukemia (ALL), but the roles that polymorphisms in folate-related genes (FRGs) play in HD-MTX toxicity and prognosis in children with ALL are not understood. The aims of this study were to investigate the frequencies of polymorphisms in the genes for thymidylate synthase (TS), methionine synthase reductase (MTRR), and methylene tetrahydrofolate reductase (MTHFR) in Turkish children with ALL and to assess associations between these polymorphisms and HD-MTX-related toxicity and leukemia prognosis in this patient group.Materials and Methods:FRG polymorphisms were assessed by real-time polymerase chain reaction. Survival status, MTX levels, and toxicity data were retrieved from 106 patients’ charts.Results:The allele frequencies for the FRG polymorphisms were as follows: TS 2R 41.0%, 3R 57.0%, and 4R 2.0%; MTRR 66A 42.4% and 66G 57.6%; MTHFR 677C 59.3% and 677T 40.7%; and MTHFR 1298A 58.1% and 1298C 41.9%. At the 48th hour of HD-MTX infusion, serum MTX was significantly higher in patients who had TS 2R/3R/4R variants as compared to those with wild-type TS (p<0.05). No significant differences were detected with respect to event-free survival or toxicity between wild-type and other FRG variants.Conclusion:The frequencies of FRG polymorphisms in Turkish children with ALL are similar to those reported in other Caucasian populations. This is the first published finding of the TS 3R/4R variant in the Turkish population. The results indicate that HD-MTX can be tolerated by leukemic children with some polymorphic variants of FRG; thus, it may prevent future risk of leukemic relapse.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Influence of Folate-Related Gene Polymorphisms on High-Dose Methotrexate-Related Toxicity and Prognosis in Turkish Children with Acute Lymphoblastic Leukemia

Yazıcıoğlu¹,

Kaya

S³

et al. 2017

Tjh

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“…We could not identify any source assessing which treatment protocols are used in pediatric oncology departments across each of the four jurisdictions. However, a number of clinical outcomes studies refer to the use of a range of international protocols, with or without adaptations, such as Berlin-Frankfurt-Munster, 42 , 43 Children’s Cancer Group, Children’s Oncology Group, 44 , 45 St Jude Total, 46 , 47 National Wilms Tumor Study 48 ; or national protocols (eg, in Turkey). 49 , 50 Turkey appears to be the only country in the sample where a national-level professional association (Turkish Pediatric Oncology Group) produces treatment protocols and guidelines, and conducts studies to assess their outcomes.…”

Section: Resultsmentioning

confidence: 99%

Economics of Pediatric Cancer in Four Eastern Mediterranean Countries: A Comparative Assessment

Gheorghe

Chalkidou

Shamieh

et al. 2020

JCO Global Oncology

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PURPOSE Cancer is a leading cause of death among children in the Eastern Mediterranean region, where conflict and economic downturn place additional burden on the health sector. In this context, using economic evidence to inform policy decisions is crucial for maximizing health outcomes from available resources. We summarized the available evidence on the economics of pediatric cancer in Jordan, Lebanon, the occupied Palestinian territory, and Turkey. METHODS A scoping review was performed of seven academic databases and gray literature pertaining to pediatric cancer in the four jurisdictions, published between January 1, 2010, and July 17, 2019. Information was extracted and organized using an analytical framework that synthesizes economic information on four dimensions: the context of the health system, the economics of health care inputs, the economics of service provision, and the economic consequences of disease. RESULTS Most of the economic evidence available across the four jurisdictions pertains to the availability of health care inputs (ie, drugs, human resources, cancer registration data, and treatment protocols) and individual-level outcomes (either clinical or health-related quality of life). We identified little evidence on the efficiency or quality of health care inputs and of pediatric cancer services. Moreover, we identified no studies examining the cost-effectiveness of any intervention, program, or treatment protocol. Evidence on the economic consequences of pediatric cancer on families and the society at large was predominantly qualitative. CONCLUSION The available economic evidence on pediatric cancer care in the four countries is limited to resource availability and, to an extent, patient outcomes, with a substantial gap in information on drug quality, service provision efficiency, and cost-effectiveness. Links between researchers and policymakers must be strengthened if pediatric cancer spending decisions, and, ultimately, treatment outcomes, are to improve.

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“…Çocukluk çağı akut lösemilerinin hastalıksız sağ kalımında izlenen büyük artışta, gelişen hasta bakım hizmetleri ve destek tedavisi yanında çok yüksek dozlarda kombine kemoterapi uygulanmasının önemli rolü vardır (1). Akut lösemiden kurtulan çocukların uzun dönem izlemlerindeki en büyük sorun, uygulanan kemoterapilere bağlı gelişen organ toksisitesidir (2).…”

Section: Introductionunclassified

Akut Losemili Cocuklarda Antrasiklin Kullanimina Bagli Kardiyotoksisitenin Degerlendirilmesi

2018

GMJ

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Giriş: Akut lösemiden kurtulan çocukların uzun dönem izlemlerindeki en büyük sorun, kemoterapilere bağlı gelişen organ toksisitesidir. Antrasiklin kullanımına bağlı gelişen toksisite en önemli morbidite ve mortalite nedenlerinden biridir. Biz de kliniğimizde son 10 yılda tanı ve tedavi almış akut lösemili olguların, akut, erken ve geç dönem antrasiklin toksisitesini değerlendirmek için farklı zamanlarda yapılan ekokardiyografik (eko) verilerini inceledik. Yöntem:Çalışmamızda BFM-95 protokolüne göre tedavi edilen 80 ALL'li, MRC-12 protokolüne göre tedavi edilen 21 AML' li olgunun tedavi öncesi (T0) ve tedavi sonrası 3-6. aylar (T1), 6-12. aylar (T2), 12-24. aylar (T3) arası ile 24. ay (T4) sonrası farklı zamanlarda yapılan eko verileri ve risk faktorleri ile 21 sağlıklı kontrolun eko verileri kaydedildi. Bulgular: Tedavi sonrası hiçbir olguda akut dönemde kardiyak toksisite izlenmedi. Tedavi sonrası erken dönemde mitral E/A-velosite (vel), trikuspid E/Avel değerlerinin kontrol grubu değerlerine göre azalmaya başladığı, tedavinin 1. yılından sonra mitral E/A-vel, trikuspid E/A-vel, ejeksiyon fraksiyonu ve fraksiyonel kısalma parametrelerinde tedavi öncesi ve kontrol grubu değerlerine göre istatistiksel azalma saptanmıştır (p<0.05). Uzun süreli izlemde toksisite gelişen %10-15 olgunun ise 550mg/m 2 den fazla antrasiklin tedavisi alan ve relaps AML'li olgular olduğu tespit edilmiştir. Sonuç: Araştırmamız, akut lösemili olguların uzun dönem izleminde toksisite evrelemesinde kullanılan eko'nun halen ilk sırada tercih edilecek ucuz ve noninvaziv bir tetkik olduğuna işaret etmektedir.

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ALL-BFM 95 Treatment in Turkish Children with Acute Lymphoblastic Leukemia—Experience of a Single Center

Cited by 18 publications

References 23 publications

Influence of Folate-Related Gene Polymorphisms on High-Dose Methotrexate-Related Toxicity and Prognosis in Turkish Children with Acute Lymphoblastic Leukemia

Influence of Folate-Related Gene Polymorphisms on High-Dose Methotrexate-Related Toxicity and Prognosis in Turkish Children with Acute Lymphoblastic Leukemia

Economics of Pediatric Cancer in Four Eastern Mediterranean Countries: A Comparative Assessment

Akut Losemili Cocuklarda Antrasiklin Kullanimina Bagli Kardiyotoksisitenin Degerlendirilmesi

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