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Survival Benefit for Individuals With Constitutional Mismatch Repair Deficiency Undergoing Surveillance
Journal of clinical oncology : official journal of the American Society of Clinical Oncology
  • Carol Durno, Hospital for Sick Children University of Toronto
  • Ayse Bahar Ercan, Hospital for Sick Children University of Toronto
  • Vanessa Bianchi, Hospital for Sick Children University of Toronto
  • Melissa Edwards, Hospital for Sick Children University of Toronto
  • Melyssa Aronson, Mount Sinai Hospital of University of Toronto
  • Melissa Galati, Hospital for Sick Children University of Toronto
  • Eshetu G. Atenafu, University of Toronto
  • Gadi Abebe-Campino, Chaim Sheba Medical Center Israel
  • Abeer Al-Battashi, Ministry of Health Oman
  • Musa Alharbi, King Fahad Medical City
  • Vahid Fallah Azad, MAHAK Pediatric Cancer Treatment and Research Center
  • Hagit N. Baris, Genetics Institute
  • Donald Basel, Medical College of Wisconsin
  • Raymond Bedgood, Coliseum Medical Centers
  • Anne Bendel, Children's Hospitals and Clinics of Minnesota
  • Shay Ben-Shachar, Tel Aviv Sourasky Medical Center
  • Deborah T. Blumenthal, Tel Aviv University
  • Maude Blundell, Sutter Health
  • Miriam Bornhorst, DC
  • Annika Bronsema, Universitätsklinikum Hamburg-Eppendorf
  • Elizabeth Cairney, London Health Sciences Centre
  • Sara Rhode, Cleveland Clinic Foundation
  • Shani Caspi, Chaim Sheba Medical Center Israel
  • Aghiad Chamdin, MSU College of Human Medicine
  • Stefano Chiaravalli, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
  • Shlomi Constantini, Tel Aviv Sourasky Medical Center
  • Bruce Crooks, IWK Health Centre
  • Anirban Das, Hospital for Sick Children University of Toronto
  • Rina Dvir, Tel Aviv Sourasky Medical Center
Document Type
Article
Publication Date
9-1-2021
URL with Digital Object Identifier
10.1200/JCO.20.02636
Abstract

PURPOSE: Constitutional mismatch repair deficiency syndrome (CMMRD) is a lethal cancer predisposition syndrome characterized by early-onset synchronous and metachronous multiorgan tumors. We designed a surveillance protocol for early tumor detection in these individuals. PATIENTS AND METHODS: Data were collected from patients with confirmed CMMRD who were registered in the International Replication Repair Deficiency Consortium. Tumor spectrum, efficacy of the surveillance protocol, and malignant transformation of low-grade lesions were examined for the entire cohort. Survival outcomes were analyzed for patients followed prospectively from the time of surveillance implementation. RESULTS: A total of 193 malignant tumors in 110 patients were identified. Median age of first cancer diagnosis was 9.2 years (range: 1.7-39.5 years). For patients undergoing surveillance, all GI and other solid tumors, and 75% of brain cancers were detected asymptomatically. By contrast, only 16% of hematologic malignancies were detected asymptomatically (P < .001). Eighty-nine patients were followed prospectively and used for survival analysis. Five-year overall survival (OS) was 90% (95% CI, 78.6 to 100) and 50% (95% CI, 39.2 to 63.7) when cancer was detected asymptomatically and symptomatically, respectively (P = .001). Patient outcome measured by adherence to the surveillance protocol revealed 4-year OS of 79% (95% CI, 54.8 to 90.9) for patients undergoing full surveillance, 55% (95% CI, 28.5 to 74.5) for partial surveillance, and 15% (95% CI, 5.2 to 28.8) for those not under surveillance (P < .0001). Of the 64 low-grade tumors detected, the cumulative likelihood of transformation from low-to high-grade was 81% for GI cancers within 8 years and 100% for gliomas in 6 years. CONCLUSION: Surveillance and early cancer detection are associated with improved OS for individuals with CMMRD.

Citation Information
Carol Durno, Ayse Bahar Ercan, Vanessa Bianchi, Melissa Edwards, et al.. "Survival Benefit for Individuals With Constitutional Mismatch Repair Deficiency Undergoing Surveillance" Journal of clinical oncology : official journal of the American Society of Clinical Oncology Vol. 39 Iss. 25 (2021) p. 2779 - 2790
Available at: http://works.bepress.com/elizabeth-cairney/5/