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Acute Leukemias in Children
Archives of Medical Research 47 (2016) 583e584
PREFACE
Acute Leukemias in Children Acute leukemia is the most common type of childhood cancer. Despite having a common term to denominate these diseases, it encloses several subtypes that, depending on their morphological, biological and molecular features, clinical presentation, response to chemotherapy and survival are determined. Appropriately trained personnel are required in order to classify leukemia according to morphology, immunophenotype and evaluation of molecular features at the time of diagnosis. Therefore, an interdisciplinary team including a medical specialist, a chemist trained in leukemia immunology and a molecular biologist is needed. The same is required to study the prognosis of leukemia or for identifying risk factors associated with disease development. Furthermore, nowadays it is clear that each leukemia subtype requires specific treatment, even within the same morphological classification. This seems to also be true in etiology, being different for each leukemia subtype even within the same lineage depending on the molecular alteration identified in each patient. The current supplemental issue of Archives of Medical Research shows a perspective of childhood leukemia from different approaches, in particular, for lymphoid leukemia. Different studies addressing cellular biology of leukemia, search for genetic biomarkers associated with prognosis or even etiology of the disease, as well as different environmental factors associated with the development of leukemia in children analysis, aspects related to parental occupational exposure or traffic density so relevant nowadays, are included. In many of these reports, the necessity of conducting multicenter, multidisciplinary and interdisciplinary studies is highlighted. Without these characteristics, it be would very difficult to draw relevant conclusions about the behavior of childhood leukemia. In this supplement, particular emphasis has been placed on interdisciplinary research. This is intended to encourage a large number of countries, especially in Latin America, to collaborate with several disciplines in order to describe the behavior of leukemias, which frequently show differences according to ethnicity or to the geographic location where they are studied. To acknowledge that the black population has a lower incidence of childhood leukemia than Hispanics who, as a matter of fact have an extremely high frequency of
leukemia, observation was required of several populations and multidisciplinary collaborations. This is of extreme importance because even within countries that could be considered more homogeneous like the Mexican mestizo population, great variability among different regions of the country is demonstrated. This supplement may be considered an example to encourage carrying out multicenter studies within populations in order to achieve a further understanding of the behavior of this disease. Particularly in developing countries, it is not often possible to exclude the participation of the quality of medical care in the evolution of leukemia patients, which may be the most influential factor in the survival of these children. It cannot be overlooked that there are children in poor countries who have favorable disease outcomes. However, quality of care problems continue to exist in many countries and there is a group of children who are in the midst of conditions and who could have better results. Regardless of the limitation of resources, if leukemia is well typified, a higher probability exists for a better prognosis. A more precise treatment stratification should be an important issue to pursue, not only in countries with highly developed technology but perhaps more necessarily in underdeveloped nations. To adequately identify the disease and to identify the best treatment along with the most appropriate doses must be the challenge for all countries, but especially developing countries where limited resources must be used more judiciously and with higher precision. This supplement demonstrates the high relevance of Phlike acute lymphoblastic leukemia, which also has been reported in a high frequency in different populations such as the Hispanic population. In spite of this, very few countries in Latin America perform this characterization. The genomic profile of childhood acute myeloid leukemia (c-AML) with gene mutations that currently define AML has been reported in this supplemental journal. The occurrence of driver mutation that has a substantial effect on overall survival of c-AML in Latin America is very informative. This supplement was also intended to encourage interdisciplinary multicenter research and to emphasize the urgent necessity of a greater use of available technological tools aimed to identify those patients who will respond to the required specific treatment and doses. We have transitioned from evidence-based medicine to individualized
0188-4409/$ - see front matter. Copyright Ó 2017 IMSS. Published by Elsevier Inc. http://dx.doi.org/10.1016/j.arcmed.2017.01.005
584
Mejıa-Arangure et al. / Archives of Medical Research 47 (2016) 583e584
medicine and now to precision medicine. No country must be excluded from this. In the future, we strive to discuss leukemia as a rare disease that is becoming even more rare, but the urgency now is that independent of its rarity, this disease will no longer impact mortality of children worldwide. We wish to provide precision medicine, but we must demonstrate its utility and that we can provide appropriate treatment with the correct doses needed for the specific disease. With these aims, we will carry out useful science that allows us to better use resources for research and medical care. JUAN MANUEL MEJIA-ARANGURE Unidad de Investigacion en Epidemiologıa Clınica UMAE Hospital de Pediatrıa and Coordinacion de Investigacion en Salud Centro Medico Nacional Siglo XXI Instituto Mexicano del Seguro Social Mexico City, Mexico
MARIA S. POMBO-DE-OLIVEIRA Programa de Hematologia-Oncologia Pediatrico CPq-Instituto Nacional de C^ancer Rio de Janeiro, Brazil
CHARLES G. MULLIGHAN Department of Pathology St. Jude Children’s Research Hospital Memphis, TN, USA Address reprint requests to: Juan Manuel MejIa-Arangure, Unidad de Investigacion en Epidemiologıa Clınica, UMAE Hospital de Pediatrıa and Coordinacion de Investigacion en Salud, Centro Medico Nacional Siglo XXI, Av. Cuauhtemoc 330, 4o Piso Edificio de las Academias, Centro Medico Nacional Siglo XXI, 06720 Mexico City, Mexico; Phone: (þ52) (55) 5627-6942; FAX: (þ521) (55) 5761-0841; E-mail: [email protected] or [email protected] Received for publication December 30, 2016; accepted January 16, 2017 (ARCMED-D-17-00026).
PREFACE
Acute Leukemias in Children Acute leukemia is the most common type of childhood cancer. Despite having a common term to denominate these diseases, it encloses several subtypes that, depending on their morphological, biological and molecular features, clinical presentation, response to chemotherapy and survival are determined. Appropriately trained personnel are required in order to classify leukemia according to morphology, immunophenotype and evaluation of molecular features at the time of diagnosis. Therefore, an interdisciplinary team including a medical specialist, a chemist trained in leukemia immunology and a molecular biologist is needed. The same is required to study the prognosis of leukemia or for identifying risk factors associated with disease development. Furthermore, nowadays it is clear that each leukemia subtype requires specific treatment, even within the same morphological classification. This seems to also be true in etiology, being different for each leukemia subtype even within the same lineage depending on the molecular alteration identified in each patient. The current supplemental issue of Archives of Medical Research shows a perspective of childhood leukemia from different approaches, in particular, for lymphoid leukemia. Different studies addressing cellular biology of leukemia, search for genetic biomarkers associated with prognosis or even etiology of the disease, as well as different environmental factors associated with the development of leukemia in children analysis, aspects related to parental occupational exposure or traffic density so relevant nowadays, are included. In many of these reports, the necessity of conducting multicenter, multidisciplinary and interdisciplinary studies is highlighted. Without these characteristics, it be would very difficult to draw relevant conclusions about the behavior of childhood leukemia. In this supplement, particular emphasis has been placed on interdisciplinary research. This is intended to encourage a large number of countries, especially in Latin America, to collaborate with several disciplines in order to describe the behavior of leukemias, which frequently show differences according to ethnicity or to the geographic location where they are studied. To acknowledge that the black population has a lower incidence of childhood leukemia than Hispanics who, as a matter of fact have an extremely high frequency of
leukemia, observation was required of several populations and multidisciplinary collaborations. This is of extreme importance because even within countries that could be considered more homogeneous like the Mexican mestizo population, great variability among different regions of the country is demonstrated. This supplement may be considered an example to encourage carrying out multicenter studies within populations in order to achieve a further understanding of the behavior of this disease. Particularly in developing countries, it is not often possible to exclude the participation of the quality of medical care in the evolution of leukemia patients, which may be the most influential factor in the survival of these children. It cannot be overlooked that there are children in poor countries who have favorable disease outcomes. However, quality of care problems continue to exist in many countries and there is a group of children who are in the midst of conditions and who could have better results. Regardless of the limitation of resources, if leukemia is well typified, a higher probability exists for a better prognosis. A more precise treatment stratification should be an important issue to pursue, not only in countries with highly developed technology but perhaps more necessarily in underdeveloped nations. To adequately identify the disease and to identify the best treatment along with the most appropriate doses must be the challenge for all countries, but especially developing countries where limited resources must be used more judiciously and with higher precision. This supplement demonstrates the high relevance of Phlike acute lymphoblastic leukemia, which also has been reported in a high frequency in different populations such as the Hispanic population. In spite of this, very few countries in Latin America perform this characterization. The genomic profile of childhood acute myeloid leukemia (c-AML) with gene mutations that currently define AML has been reported in this supplemental journal. The occurrence of driver mutation that has a substantial effect on overall survival of c-AML in Latin America is very informative. This supplement was also intended to encourage interdisciplinary multicenter research and to emphasize the urgent necessity of a greater use of available technological tools aimed to identify those patients who will respond to the required specific treatment and doses. We have transitioned from evidence-based medicine to individualized
0188-4409/$ - see front matter. Copyright Ó 2017 IMSS. Published by Elsevier Inc. http://dx.doi.org/10.1016/j.arcmed.2017.01.005
584
Mejıa-Arangure et al. / Archives of Medical Research 47 (2016) 583e584
medicine and now to precision medicine. No country must be excluded from this. In the future, we strive to discuss leukemia as a rare disease that is becoming even more rare, but the urgency now is that independent of its rarity, this disease will no longer impact mortality of children worldwide. We wish to provide precision medicine, but we must demonstrate its utility and that we can provide appropriate treatment with the correct doses needed for the specific disease. With these aims, we will carry out useful science that allows us to better use resources for research and medical care. JUAN MANUEL MEJIA-ARANGURE Unidad de Investigacion en Epidemiologıa Clınica UMAE Hospital de Pediatrıa and Coordinacion de Investigacion en Salud Centro Medico Nacional Siglo XXI Instituto Mexicano del Seguro Social Mexico City, Mexico
MARIA S. POMBO-DE-OLIVEIRA Programa de Hematologia-Oncologia Pediatrico CPq-Instituto Nacional de C^ancer Rio de Janeiro, Brazil
CHARLES G. MULLIGHAN Department of Pathology St. Jude Children’s Research Hospital Memphis, TN, USA Address reprint requests to: Juan Manuel MejIa-Arangure, Unidad de Investigacion en Epidemiologıa Clınica, UMAE Hospital de Pediatrıa and Coordinacion de Investigacion en Salud, Centro Medico Nacional Siglo XXI, Av. Cuauhtemoc 330, 4o Piso Edificio de las Academias, Centro Medico Nacional Siglo XXI, 06720 Mexico City, Mexico; Phone: (þ52) (55) 5627-6942; FAX: (þ521) (55) 5761-0841; E-mail: [email protected] or [email protected] Received for publication December 30, 2016; accepted January 16, 2017 (ARCMED-D-17-00026).