Nutritional status at diagnosis of children with malignancies in Casablanca.

INTRODUCTION: Nutritional assessment is an essential component of the initial assessment of children with cancer. Malnutrition may be present at diagnosis due to the effects of the malignancy or, in low income countries (LIC), due to poverty and an inadequate diet. PURPOSE: The aim of this study is to evaluate the prevalence of malnutrition at diagnosis in children with cancer in Morocco. PROCEDURE: Nutritional status of 100 children aged less than 18 years with newly diagnosed malignancy between January 2005 and January 2006 was evaluated by anthropometric and biochemical parameters before initiating therapy. We measured weight, height, weight-for-height using z-scores index for children and body mass index for adolescents, triceps skinfold thickness and mid-upper arm circumference, and serum albumin. RESULTS: A total of 100 patients were included. The mean age was 7 years (range 1 to 18 years). Sixty percent were boys. The diagnosis was: Burkitt lymphoma (n = 19), acute myeloblastic leukaemia (n = 18), acute lymphoblastic leukaemia (n = 14), rhabdomyosarcoma (n = 13), Ewing sarcoma (n = 7), nephroblastoma (n = 6), Hodgkin disease (n = 5), osteosarcoma (n = 5), retinoblastoma (n = 4), neuroblastoma (n = 3), germ cell tumor (n = 3), orbital lymphoma (n = 1), cerebral lymphoma (n = 1), ependymoma (n = 1). Incidence of malnutrition ranged from 20 to 50%, depending upon the measurement used. CONCLUSION: The prevalence of malnutrition in this study was high, so interventions are being implemented to improve the nutritional status of these patients.

Characterization of acute lymphoblastic leukemia subtypes in moroccan children.

We present the incidence and the immunologic characteristics of acute lymphoblastic leukemia (ALL) subsets in Moroccan children. We studied 279 unselected patients below the age of 18 years with newly diagnosed ALL. Cases were classified according to immunophenotype: 216 (77.42%) precursor B-cell phenotype (pB-cell), mature B-cell in 4 (1.43%), and T-cell in 59 (21.15%) cases. The subclassification using the CD10 antibody revealed 197 cases pB-ALL CD10+ (91.2%) and 9 cases T-ALL CD10+ (19.2%). The age distribution showed a peak in incidence between 3 and 5 years among the pB-cell ALLs subtype. There was a significantly higher frequency of males in the T-ALL subset (M/F ratio: 2.93 : 1) and more females in the T-ALL CD10+ subset when compared with the T-ALL CD10- subset. All tested pB-cell-lineage ALLs expressed CD19, CD79a, and surface CD22, terminal deoxynucleotidyl transferase (TdT) was detectable in 89.9% of cases, and cells in 74.1% of cases express CD34. All tested T-lineage ALL cells have surface CD7 and cytoplasmic CD3 (cCD3) antigens, CD5 was found in 98.2% cases, and 70.5% express TdT. CD1a, surface CD3 (sCD3), and CD4 are detected in more than 80% of cases; this frequency is higher than the 45% generally observed. Myeloid antigens occur more frequently and were expressed in 124 (57.4%) of pB-cell-ALL cases and 20 (33.9%) of T-cell ALL cases. Our results show that the distribution of ALLs in Moroccan children is similar with the general distribution pattern in developed countries except for the high frequency of T-ALL phenotype. The phenotypic profiles of our patients are close to those reported in literature for B-lineage ALLs; for the T-cell ALL subgroup, the blast cells express more CD1a, surface CD3, and CD4 while expressing less TdT. The high frequency of CD1a expression resulted in an excess of the common thymocyte subtype.

Pernicious anemia associated with autoimmune hemolytic anemia and alopecia areata.

We report a 16-year-old male with a combination of pernicious anemia, auto-immune hemolytic anemia and alopecia areata. Autoimmune hemolytic anemia coexisted with pernicious anemia but was diagnosed only when the anemia failed to respond to cobalamin therapy. Alopecia areata occurred 9 years later.

Treatment of Wilms tumor according to SIOP 9 protocol in Casablanca, Morocco.

BACKGROUND: Childhood Wilms tumor represents one of the challenge for pediatric oncologists in developing countries. We report the characteristics and treatment results of patients with Wilms tumor according to SIOP 9 protocol in Morocco. PROCEDURE: From January 1989 to December 2000, 86 children with Wilms tumor were admitted. The diagnosis was based on physical exam and abdominal ultrasound. The metastatic work-up was based on abdominal ultrasound and chest X-ray. RESULTS: The mean age was 36 months (3-120 months). The sex-ratio was 1. Abdominal mass was the main symptom at presentation (84 cases). There were 13 metastatic cases. Treatment applied was according to SIOP 9 Protocol without randomization. Local deases was present in 75 patients with stage I in 38 cases (50%), IIN0 in 4 cases (6%), IIN1 in 9 cases, and III in 24 cases (44%). The distribution of pathologic groups was: favorable in 4 cases, standard in 69 cases, and unfavorable anaplastic type in 2 cases. Sixty-nine patients were evaluable for therapeutic evaluation. Other patients were lost to follow-up. Three patients died of treatment related toxicity and 13 patients relapsed. With a median follow-up of 70 months, the 5-year EFS and 5 years overall survival for evaluable patients are 77.4% and 79%, respectively while the 5-year EFS for all patients was 56%. CONCLUSION: These results are encouraging for a developing country but special efforts should be done to reduce the rate of abandonment.

[Treatment of childhood Burkitt lymphoma according to LMB89 protocol in Casablanca]. / Traitement du lymphome de Burkitt de l'enfant par le protocole LMB89 à Casablanca.

During the two last decades, the prognosis of children with Burkitt lymphoma has improved dramatically. Treating patients with Bukitt lymphoma in countries with limited resources is a challenge. We report our results in a serie of 95 children with Burkitt lymphoma treated between September 1990 and December 2000 according to SFOP LMB89 protocol. The median age was 45 months (range 8 months, 18 years). Seventy three percent of patients had abdominal tumor and 10% had maxillary tumor. According to Murphy classification, one patient had stage I, 17 patients stage II, 60 patients stage III and 17 patients stage IV. When considering the LMB prognosis groups, 1 patient was in group A, 83 were in group B and 11 were in group C. 73 patients were evaluables for treatment results. Complete remission was achieved in 50 patients, of whom 6 relapsed. 18 patients died from early treatment toxicity. The 5 years relapse free survival rate was 56%. It was at 100%, 84%, 52% and 38% for stage I, II, III and IV respectively. These results are below what is expected with this protocol. Improvement of supportive-care is the main condition to reach western results.