Browsing by Author "Geel, Jennifer Ann"

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    The Feasibility of Introducing a Harmonised Treatment Regimen, Comparing Affordable Blood Tests and PET-CT Scans, to Improve Two-Year Survival Rates in Children, Adolescents and Young Adults with Hodgkin Lymphoma in South Africa
    (University of the Witwatersrand, Johannesburg, 2024) Geel, Jennifer Ann; Ballot , Daynia; Metzger, Monika
    Paediatric classical Hodgkin lymphoma (cHL) is highly curable using chemotherapy and radiotherapy. Prior to this study, no collaborative, prospective cHL studies had been performed in South Africa. The retrospective assessment informed the creation of the prospective harmonised guideline. We aimed to determine a baseline survival rate and prognostic factors; explore reasons for mortality in HIV-positive patients, assess the feasibility of introducing a harmonised treatment guideline, prospectively assess survival and analyse the prediction of chemosensitivity at interim assessment. In the retrospective analysis, multiple potential prognostic factors were analysed and survival rates calculated with Kaplan-Meier curves and Cox regression analysis. An initial survey was conducted of the clinical researchers before the launch of the prospective study, followed by a mid-study assessment. Two-year overall survival was calculated by Kaplan-Meier curves and computer-learning models were utilised to compare chemosensitivity based on interim PET-CT assessment with changes in haematological and non-specific markers of disease activity. The retrospective analysis accrued 294 patients, of whom 29 were HIV-positive. The 5-year overall survival was 84% in HIV-negative and 49% in HIV-positive patients. Advanced stage, HIV infection and treatment with regimens other than doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) were associated with lower survival rates. In HIV-positive patients, an AIDS-defining CD4 count and hypoalbuminaemia were associated with poorer prognosis. The pre-study assessment indicated that the majority of centres fulfilled all criteria to participate in the study. The mid-study assessment identified barriers to participation and methods to mitigate these challenges. Analysis of 132 prospectively accrued patients (19 HIV-positive, 113 HIV-negative) treated on a risk-stratified, response-adjusted treatment regimen resulted in higher survival rates of 93% in HIV-negative and 89% in HIV-positive patients. Changes in low-cost, widely available blood tests correctly predicted chemosensitivity, identifying patients who may not require radiotherapy. In conclusion, higher survival rates for paediatric cHL were documented following the introduction of a harmonised management guideline in South Africa. In settings that do not have access to PET-CT, changes in affordable blood tests may be used to substitute for xvi radiological interim assessment, although a format suitable for individual patients is yet to be developed for the clinical setting. This research marks the inaugural collaborative effort where patients from every South African paediatric oncology unit and the majority of private paediatric oncology practices, were afforded the opportunity to participate in a prospective study aimed at enhancing survival rates.
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    Toxicity and survival rates in 75 paediatric patients with germ cell tumours treated over a 28 year period at the Charlotte Maxeke Johannesburg academic hospital
    (2016-10-14) Geel, Jennifer Ann
    Germ cell tumours have a good prognosis if treated aggressively but the consequence of cure may be life-altering toxicity. Prolonged duration of symptoms is often thought to contribute to poor outcomes in patients with solid tumours. Aims: To document incidence, survival rates, extent of treatment-related toxicity and to identify poor prognostic indicators in children with germ cell tumours treated at the Charlotte Maxeke Johannesburg Academic Hospital. A secondary aim was to determine which classification system had validity in this cohort. Methods: A retrospective file review was conducted of children with germ cell tumours treated at the Charlotte Maxeke Johannesburg Academic Hospital over a 28 year period. Descriptive statistics were employed to document incidence, toxicity rates and outcomes. Kaplan-Meier estimations were performed to determine prognostic factors. Results: Seventy five patients were identified, 17 with benign tumours, 56 with malignant tumours and two unknown. Chemotherapy was given to 48 patients, in whom 32 (67%) experienced significant myelotoxicity. Of the 41 patients treated with cisplatin, 34% developed clinically significant hearing impairment. Five patients developed renal tubular acidosis, and two developed chronic renal failure. vi The only independent factor found to have prognostic significance was complete surgical excision. There was no correlation between prolonged duration of disease-specific symptoms and poor outcome. The classification of patients according to the IGCCC system does not appear to correlate closely with determinations of prognosis, in comparison with conventional staging systems. All patients who relapsed did so in the first 3 years after diagnosis. The 3 year overall survival rate was 77.8%. There were no recorded cases of secondary malignancies or chemotherapy-induced infertility. Conclusion Complete surgical excision is vital for survival. Transient myelotoxicity and permanent hearing impairment are common when protocols incorporating cisplatin are used. Survival rates are acceptable for a middle-income country. Every effort should be made to preserve the good survival rate while decreasing toxicity.