Please use the arrow to scroll right for additional sessions

Displaying One Session

View
SIOP Free Paper Session (FPS)

LATE BREAKING ABSTRACTS

Session Type
SIOP Free Paper Session (FPS)
Chair(s)
Room
Hall 1
Date
16.10.2020, Friday
Session Time
04:15 PM - 05:00 PM

GLOBAL OUTCOMES OF SARS-COV-2 AMONG CHILDREN WITH CANCER: AN INITIAL REPORT FROM THE ST. JUDE CHILDREN’S RESEARCH HOSPITAL (SJCRH)/SIOP GLOBAL COVID-19 CHILDHOOD CANCER REGISTRY (GCCCR)

Session Name
LATE BREAKING ABSTRACTS
Session Type
SIOP Free Paper Session (FPS)
Date
16.10.2020, Friday
Session Time
04:15 PM - 05:00 PM
Room
Hall 1
Lecture Time
04:15 PM - 04:27 PM
Presenter
Authors

Abstract

Background and Aims

In response to the need for a worldwide assessment of the impact from the COVID-19 pandemic in children with cancer, SJCRH/SIOP created a global data repository to understand the clinical course and outcomes of SARS-CoV-2 infection in this population.

Methods

The GCCCR is a deidentified data repository of laboratory-confirmed SARS-CoV-2 infection in children <19 years of age with confirmed cancer diagnosis or receipt of a hematopoietic stem cell transplant. Data include demographics, oncologic diagnosis and treatment, clinical presentation, management and outcomes, and 30-day and 60-day follow-up as indicated. To ensure a complete and representative cohort, each contributing institution was asked to verify that all patients meeting inclusion criteria were registered.

Results

Seven-hundred thirty cases (mean age 8 years, males 58%) were reported from 119 hospitals (35 countries) through August 10, 2020. Acute lymphoblastic leukemia/lymphoma was the most frequently reported diagnosis (47%;n=344/730). Six-hundred four (83%;n=604/730) patients were receiving cancer-directed therapy at the time of SARS-CoV-2 diagnosis. Four-hundred seventy-one cases have completed 30-day follow-up (65%;n=471/730). Eighty-six (18%;n=86/471) were classified as severe or critical infection based on organ dysfunction or requirement for admission to higher level of care. Absolute lymphocyte count </=300 cells/mm3 (p<0.0001) and absolute neutrophil count </=500 cells/mm3 (p=0.002) were associated with severe/critical illness. Three-hundred fifty-six (76%;n=356/471) patients had documented clinical and/or laboratory resolution of infection, while 5% (n=23/471) had mortality attributed to SARS-CoV-2 infection. Chemotherapy was reduced or withheld in 45% (n=210/471) of patients.

Conclusions

The GCCCR represents the largest global cohort of childhood cancer patients with SARS-CoV-2 infection. While most clinical outcomes are favorable, severe disease and infection-related mortality does occur. Modifications to cancer-directed therapy are frequent but their impact on long-term outcomes remains uncertain. As an implementation model, the GCCCR has proven an effective mechanism to facilitate global collaboration to understand the impact of the COVID-19 pandemic in a rare-disease population.

Hide

PHENOTYPES OF NEUROCOGNITIVE IMPAIRMENT IN LONG-TERM SURVIVORS OF CHILDHOOD CANCER: A REPORT FROM THE ST. JUDE LIFETIME COHORT STUDY

Session Name
LATE BREAKING ABSTRACTS
Session Type
SIOP Free Paper Session (FPS)
Date
16.10.2020, Friday
Session Time
04:15 PM - 05:00 PM
Room
Hall 1
Lecture Time
04:27 PM - 04:39 PM
Presenter
Authors

Abstract

Background and Aims

Phenotypic profiles of impairment across multiple neurocognitive measures have not been well-characterized in long-term survivors of childhood cancer. This study examined profiles across a large, heterogeneous group of survivors.

Methods

Twenty neurocognitive abilities were evaluated in 2,958 survivors of childhood cancer (mean[SD] age 34.1[9.4] years; 25.7[9.3] years post-diagnosis; 47% female) enrolled in the St. Jude Lifetime Cohort Study. Neurocognitive impairment was defined as an age-adjusted z-score <-2.0 (2.3% expected in the general population) for each measured ability. Latent class analysis was used to identify phenotypic patterns of neurocognitive impairment. Chronic health conditions (CHCs) were classified according to CTCAE criteria (grade 1=mild, 2=moderate, 3=severe/disabling, 4=life-threatening) then combined into a severity/burden score by frequency and grade (no/low, medium, high, very high). Multinomial logistic regression examined the impact of cancer therapy and CHC severity/burden on neurocognitive phenotype class membership, adjusting for sex, age at diagnosis, and time since diagnosis.

Results

Five mutually exclusive neurocognitive phenotypes were identified: global impairment (n=109; 3.7%), attention impairment (n=163; 5.5%), executive function/processing speed impairment (n=295; 10.0%), memory impairment (n=217; 7.3%), and no impairment (n=2,174; 73.5%). Relative risks (RR) for global impairment and memory impairment were higher for survivors with exposure to neurosurgery (global RR=3.49, 95%CI 1.68-7.27; memory RR=1.72, 95%CI 1.04-2.86) or cranial irradiation (per 10 Gy; global RR=1.47, 95%CI 1.29-1.68; memory RR=1.11, 95%CI 1.001-1.23). Survivors of CNS tumors had the highest relative proportions of class membership for global (12.1%), executive function/processing speed (20.4%), and memory impairment (13.4%), while survivors of acute lymphoblastic leukemia had the highest proportion of attention impairment (5.8%). The risk for global versus no impairment was 20-fold greater for survivors with very high CHC severity/burden scores (OR=20.17, 95%CI 11.41-35.63) compared to survivors with no/low/medium severity/burden.

Conclusions

Long-term survivors of childhood cancer present with distinct phenotypes of neurocognitive impairment, which will require personalized and multi-faceted therapeutic approaches to rehabilitation.

Hide

DNA-THIOGUANINE CONCENTRATION AND RELAPSE RISK IN CHILDREN AND YOUNG ADULTS WITH ACUTE LYMPHOBLASTIC LEUKEMIA: AN IPD META-ANALYSIS

Session Name
LATE BREAKING ABSTRACTS
Session Type
SIOP Free Paper Session (FPS)
Date
16.10.2020, Friday
Session Time
04:15 PM - 05:00 PM
Room
Hall 1
Lecture Time
04:39 PM - 04:51 PM
Presenter
Authors

Abstract

Background and Aims

Methotrexate/6-mercaptopurine maintenance therapy improves acute lymphoblastic leukemia (ALL) outcome. Cytotoxicity is mediated by DNA incorporation of thioguanine nucleotides (DNA-TG). We investigated the association of DNA-TG to relapse risk in ALL.

Methods

We included 1,910 children and young adults with non-high risk ALL treated across six international protocols and calculated the time weighted means of DNA-TG (wmDNA-TG).

Results

For patients who completed therapy, remained in first remission, and had at least ten DNA-TG measurements, the median wmDNA-TG was 415 (75% range: 282–587) fmol/µg DNA. Cohort-stratified Cox regression analysis adjusted for sex, age, and white cell count at diagnosis revealed a relapse-specific hazard ratio (HRa) per 100 fmol/μg increase in weighted mean (wmDNA-TG) of 0.87 (95% CI 0.78–0.97; p=0.013) in the 839 patients who were minimal residual disease (MRD) positive at end of induction therapy (EOI), whereas this was not the case in EOI MRD-negative patients (p=0.76). Validation analysis excluding the previously published Nordic NOPHO ALL2008 pediatric cohort yielded a HRa of 0.92 (95% CI 0.82–1.03; p=0.15) per 100 fmol/μg increase in wmDNA-TG in EOI MRD-positive patients. If also excluding the United Kingdom cohort, in which samples were taken non-randomly in selected patients, the HRa for the EOI MRD-positive patients was 0.82 (95% CI 0.68–0.99; p=0.044) per 100 fmol/μg increase in wmDNA-TG.

Conclusions

The importance of DNA-TG as a biomarker for maintenance therapy intensity calls for novel strategies to increase DNA-TG, although its clinical value may vary by protocol backbone.

Hide

Live Q&A

Session Name
LATE BREAKING ABSTRACTS
Session Type
SIOP Free Paper Session (FPS)
Date
16.10.2020, Friday
Session Time
04:15 PM - 05:00 PM
Room
Hall 1
Lecture Time
04:51 PM - 05:00 PM
Presenter
Authors