Annual Meeting Proceedings Part 1 - American Society of Clinical ...

620s Pediatric Oncology
9557 General Poster Session (Board #41D), Sun, 8:00 AM-12:00 PM
Diagnostic and treatment challenges of adolescent and young adult
oncology patients. Presenting Author: Yanqing Xu, McGill Adolescent and
Young Adult Oncology Program, Montreal, QC, Canada
Background: Adolescent and young adult (AYA) cancer patients are faced
with obstacles and challenges related to their diagnosis and treatment
compared to children and older adults. The aim of this study was to explore
the patient and health care system-related delays in the interval from
cancer symptom onset to diagnosis and treatment as well as to identify the
possible contributing factors to these delays in the AYA group. Methods:
This study was based on a questionnaire conducted in 2010-2011
completed by patients diagnosed with a malignancy between the ages of 16
and 39 in addition to older patients diagnosed with a pediatric type
malignancy. Four categories of delays: patient delay (time from patient
symptom onset until first health care contact date), health care system
delay (time from first health care contact until diagnosis date), treatment
delay (time from diagnosis date until first treatment) and oncologist delay
(time from first health care contact until first medical oncologist meeting)
were calculated. Median delay (in days) with interquartile interval (IQI) was
the main outcome measure. Median time for each category of delay was
further analysed to explore how they vary with different patient characteristics.
Results: We identified a median patient delay of 30 days (IQI 1-131), a
median health care system delay of 53 days (IQI 1-213), a median
treatment delay of 36 days (IQI 5-92) and a median oncologist delay of 77
days (IQI 30-281). Patient delay was affected by patient gender, age at
diagnosis and type of first health care contact. Health care system delay
was associated with patient marital status, financial situation and attitude
of first health care professional. Treatment delay was related to type of
cancer. Conclusions: The health care system delay (including oncologist
delay) accounts for much of the delay from symptom onset to first
treatment. Professional characteristics of frontline medical personnel as
well as socioeconomic and biological characteristics of the patients may
contribute to delay. Healthcare professionals and the general community as
a whole need to be aware of the factors contributing to delay in diagnosis
and treatment in the underserved patient population.
9559 General Poster Session (Board #41F), Sun, 8:00 AM-12:00 PM
Results of autologous transplants for children from a tertiary cancer center
in India. Presenting Author: Amol Dongre, Tata Memorial Centre, Mumbai,
India
Background: Autologous transplantation is a curative option for children
with various malignancies. We report the results of our center with the aim
of evaluating toxicities and prognostic factors that may influence decision
making to use our limited resources judiciously. Methods: Forty-six patients
diagnosed below 18 years from 1st April 1994- 28th February 2011 were
included in this retrospective study. Twenty-four patients had lymphoma,
12- neuroblastoma and 10-others ( 5- acute leukemia, 4- Ewing sarcoma
and 1 - rhabdomyosarcoma). Twenty-eight patients received peripheral
blood stem cells, 12 – marrow and 6-both. Prognostic factors evaluated for
overall survival (OS) and progression-free survival (PFS) were remission
status at transplant, baseline and pre-transplant serum albumin, time
interval between diagnosis and transplant, type of malignancy and number
of lines of chemotherapy pre transplant. Results: Median age at diagnosis
and transplant were 9 and 12 years respectively. Median baseline and pre
transplant serum albumin were 3.6 and 3.9 g/dl. Median number of lines of
chemotherapy was 2. Median time from diagnosis to transplant was 1.1
years. Incidence of grade 3 and 4 oral mucositis and diarrhea were 46%
and 25% respectively. At the time of transplant, 45% were in complete
remission (CR), 41% in partial remission (PR) and 13% in refractory state.
Total Parenteral Nutrition (TPN) was used in 63% patients with median
duration of 11 days. No patient developed sinusoidal obstruction syndrome-
.Median days to neutrophil and platelet engraftment were 11 and 15 days
respectively. Neutropenic sepsis leading to death was seen in 17%. Median
follow up was 1.5 years. At 2 years, the probability of OS and PFS were
39% and 35% for all patients while OS and PFS for lymphoma, neuroblastoma
and others were 45% and 32%, 17% and 0% and 50% and 40%
respectively. CR at transplant was the most important determinant of better
OS (59 % vs 28%; p � 0.000004) and PFS (53% vs 8%; p �
0.0000018). Conclusions: CR at transplant is the most important prognostic
factor. Patients with neuroblastoma have dismal outcome which
requires reevaluation of transplant strategies for this group.
9558 General Poster Session (Board #41E), Sun, 8:00 AM-12:00 PM
Treatment outcomes of pediatric oncology patients in Zambia. Presenting
Author: Jeremy Slone, Vanderbilt University School of Medicine, Nashville,
TN
Background: Due to challenges in the delivery of pediatric oncology care in
low-middle income countries (LMIC), diagnosis and treatment remains
inadequate for the majority of patients. The University of Zambia School of
Medicine/University Teaching Hospital (UTH) and Vanderbilt University
School of Medicine/Vanderbilt Institute for Global Health established a
partnership to investigate treatment outcomes at UTH, the only institution
providing pediatric oncology care in Zambia, and assess risk factors
associated with treatment abandonment. Methods: A retrospective study
was conducted in a cohort of patients, presenting from July 2008 – June
2010, using an established database and medical record review. Results:
Of the 230 children enrolled in the database, 162 met the inclusion
criteria. The average age at diagnosis was 6.0 years; males comprised
55.6% of the cohort; 51.6% had a histopathological diagnosis and 10.5%
of the cohort was HIV positive. The most common diagnoses were
lymphoma (25.9%), Wilms tumor (22.8%), and retinoblastoma (17.9%).
Leukemia and Kaposi sarcoma accounted for 7.4% each. Death (46.3%)
and abandonment of treatment (45.7%) were the most common outcomes
with only 8.0% having completed treatment or currently undergoing
treatment, including palliative regimens, at the time of data acquisition.
Residence in Lusaka or Central provinces, closest in proximity to UTH, was
associated with a decreased risk for abandonment of treatment (Odds Ratio
(OR) 0.41 (95% CI 0.21-0.81, p � 0.009) while maternal education less
than secondary school (OR 2.73 95% CI 1.2-6.6, p � 0.03) was
associated with an increased risk for abandonment of treatment. Conclusions:
At the only pediatric cancer center in Zambia, treatment outcomes are dire
with the majority of the cohort abandoning treatment or dying during
therapy. Challenges include access to cancer chemotherapy, logistical
facilitation, fiscal support of radiotherapy, and community engagement.
Further investigation is required to inform effective intervention strategies
to improve outcomes.
9560 General Poster Session (Board #41G), Sun, 8:00 AM-12:00 PM
Evaluation of renal function in children with solid tumors: Comparison
between estimation with Schwartz formula and EDTA clearance. Presenting
Author: Carole Serrano, Institut Gustave Roussy-Clinical Pharmacy
department, Villejuif, France
Background: Using the [51Cr]-ethylenediamine tetra acetic acid ([51Cr]-
EDTA) method provides an accurate measure of glomerular filtration rate
(GFR) for each patient. However, this method is not always feasible in
routine. Thus, several mathematical equations have been developed to
predict creatinine clearance. The most widely used in pediatric patients is
the Schwartz formula, based on patient height and serum creatinine.
However, this method has not been validated in pediatric cancer patients.
The aim of the present study was to compare GFR measured with the
51Cr-EDTA method to GFR estimated with the Schwartz formula in
patients younger than 18 years of age and treated for solid tumors. Methods:
Data have been retrospectively collected on consecutive children treated
between 2001 and 2011 at Institut Gustave Roussy. All of the patients had
undergone assessment of GFR via 51Cr-EDTA clearance and estimation of
renal function by the Schwartz formula. Exclusion criteria were serum
creatinine under 25�mol/L or no recent dosage available. GFR analysis was
realized using the slope intercept method after a single injection of
51Cr-EDTA solution.. Values of the GFR were calculated by multiplying the
volume of dilution by the slope of the single exponential fit to the three data
points and then expressed in ml/min/1.73m². Student paired t-test (alpha
� 0.05) was used to compare results obtained for each patient with the two
methods. Results: 196 patients (120 males, 76 females), treated with
various types of cancer (neuroblastoma, osteosarcoma, Ewing sarcoma,
lymphoma. . .) Mean age was 6.7 years. Mean GFR was 127.5 ml/min/
1.73m² with the 51Cr-EDTA method versus 148.1 ml/min/1.73m² with the
Schwartz formula. Mean of difference was 20.7 ml/min/1.73m² with a
confidence interval [-25.7 ; -15.6] (p � 0.0001). Conclusions: GFR
estimated with the Schwartz formula is statistically different from the
isotopic method. In most cases, GFR estimated with the Schwartz formula
is overestimated. This study highlights the lack of accuracy of this equation
in pediatric population with cancer. The 51Cr-EDTA method must be
preferred when a reliable and accurate evaluation of renal function is
needed.
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