Background
Childhood acute lymphoblastic leukaemia (ALL) is one of the most common childhood cancers. In India, survival has historically been lower than in many high-income countries, partly because of high treatment-related mortality during intensive chemotherapy. The Indian Childhood Collaborative Leukaemia (ICiCLe) group conducted a multicentre prospective observational study and used genetics and measurable residual disease (MRD) to categorise B-cell precursor (BCP) ALL as standard (SR), intermediate (IR) and high-risk (HR) to receive increasing intensity of therapy and children with T-cell ALL received a uniform treatment approach.
Population
Between 2013 and 2018, 2695 children aged 1–18 years with newly diagnosed ALL were enrolled across six participating centres in India. The median follow-up was 61 months (range: 59–62 months). 229 (8.5%) were T-ALL patients. Patients with Down syndrome, mature B-cell and ambiguous lineage leukaemia were excluded.
Outcome Measure
4-year Event free survival (EFS) and Overall Survival (OS) of children with ALL treated using risk adapted approach. Result: Estimated 4-year event-free survival (EFS) and overall survival (OS) for the overall cohort were 62% and 74%, respectively. Survival varied significantly by risk group, with 4-year OS of 88% in Standard-Risk, 80% in Intermediate-Risk, 73% in High-Risk, and 77% in T-cell ALL, while the corresponding 4-year EFS was 76%, 70%, 61%, and 69%, respectively. These findings provide an important baseline benchmark for survival outcomes in childhood ALL in India, against which future improvements in treatment, supportive care, and outcomes can be measured.
DOI - 10.1016/j.lansea.2025.100593
Background
InPOG-HL-15-01, a multicentre prospective study aimed at describing the epidemiology and outcomes of children with HL treated in a risk-stratified, response-adapted strategy using an ABVD backbone as most of the centers in India can safely deliver this simple regimen even with limited supportive care infrastructure. RT was restricted to patients with initial bulky disease and those with suboptimal response at early response assessment (ERA) after two cycles of chemotherapy.
Population
A total of 410 patients from 27 centres were enrolled in the study over 30 months. Fourteen patients were found ineligible for analysis because of inadequate staging or response evaluation. Of the 396 eligible patients, 134 were classified as having early-stage disease and 262 advanced stage Hodgkin Lymphoma (IIB, III and IV) in children and adolescents. With a median follow-up of 52 months in the early-stage cohort and 49 months in the advanced-stage cohort.
Outcome Measure
5-year Event free survival (EFS) and Overall Survival (OS).
Result
5-year event-free survival (EFS) and overall survival (OS) were 94.0% and 95.5%, respectively, for early-stage disease, and 81.1% and 90.8%, respectively, for advanced-stage disease.
doi.org/10.1002/pbc.29219
doi.org/10.1080/10428194.2021.2012659
Background
Renal cancers are rare in children, accounting 6–7% of childhood tumors. In India, there is paucity of data on renal tumors including Wilms tumor (WT). A multidisciplinary approach with surgery, chemotherapy, supportive care, and radiotherapy treatment approach is followed in India.
Population
The study retrospectively analysed 404 children (<18 years) with Wilms tumor treated across 17 paediatric oncology centres (nine from South India; four from North India; three from West India; and one from East India) between January 2010 and June 2021. Twelve children (3%) abandoned the treatment. For the remaining 392 cases, follow-up ranged from 1 to 144 months.
Outcome Measure
1-, 3-, and 5-year event-free survival (EFS) and overall survival (OS).
Result
The study reported favourable outcomes with the 1-, 3-, and 5-year OS was 95.3, 92.4, and 91.5%, respectively. The 1-, 3-, and 5-year EFS was 91.8, 87.2, and 85.9%, respectively and a low treatment-related mortality of 1.7%. Relapse/progression was seen in 44 children (10.9%). Mortality was 6.7%. Relapse with discontinuation of treatment was the most common cause of death (3.7%), followed by death from progression on treatment (1.3%). By providing the first large multicentre benchmark of patterns of care and survival in Indian children with Wilms tumor, this study establishes a national baseline against which future improvements in treatment and outcomes can be measured.
doi.org/10.1002/pbc.31871
Background
Non-Hodgkin Lymphoma (NHL) constitutes 8.4% of childhood malignancies, B cell NHL accounts for 50–60% of the paediatric NHLs. The literature on B-non-Hodgkin lymphoma (NHL) in India is restricted to individual hospital data. The study aimed to evaluate the epidemiology and outcome of B-NHL at national level.
Population
One hundred and ninety-one patients of B-NHL from 10 centres (2 from South (Telangana and Tamil Nadu), 1 from East (West Bengal), 1 from North-West (Chandigarh), and 6 from North India (Delhi)) diagnosed between 2013 and 2016 were analysed retrospectively. The median follow-up was 21.34 (IQR: 4.34, 36.57) months.
Outcome Measure
3-year Event free survival (EFS) and Disease-free survival (DFS).
Result
Twenty-eight patients (14.7%) underwent primary surgery, the rest receiving chemotherapy upfront. Different protocols were applied for therapy at different centres. The most common protocols used were FAB-LMB-96 (French-American-British/lymphomes malins B) in 85 (45.9%) patients and BFM (Berlin–Frankfurt–Munster)-NHL-90 in 48 (25.9%) patients. Other protocols included LMB 89 and LINK regimen were used in 27 (14.6%) and 16 (8.6%) patients, respectively. BFM 95, ANHL01P1, CHOP, and GRAB were used in 2 patients each. the disease-free-survival (DFS) was 74.4% and event-free-survival (EFS) was 60.7%. Treatment-related mortality (TRM), relapse/progression and abandonment were 14.3%, 14.5%, and 8.4%, respectively.
doi.org/10.1080/08880018.2021.2002485
Background
While neuroblastoma (NB) is the most common extracranial solid tumor in children in the United States and other high-income countries (HIC), there is relatively little data on the treatment and outcome of children with NB in India, a low- and middle-income country (LMIC). This study aims to describe the clinical, management, and outcome profile of childhood neuroblastoma (NB) in India and identify barriers to optimal management.
Population
Three hundred and twenty-two children with Neuroblastoma aged under 15 diagnosed between June 2016 and August 2021 across 14 centers, with prospective follow-up for survival outcomes were analysed.
Outcome Measure
3-year Event free survival (EFS) and Overall Survival (OS).
Result
For low-risk NB, surgery was the primary modality of treatment and chemotherapy protocols used included the SIOPEN LINES and the CCG-3891. The intermediate-risk NB were treated on a variety of protocols that included COG (Children’s Oncology Group) ANBL0531, SIOPEN LINES, and CCG3891 protocol. The most common protocol used for high- risk neuroblastoma in the majority of the participating centers was the HR-NBL1-SIOPEN and CCG3891 protocol. The 3-year overall survival (OS) and event-free survival (EFS) for the entire cohort was 60% (54.1%–66.5%) and 50.2% (44.4%–56.7%) respectively.
doi.org/10.1002/1545-5017.70431
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