Scott C Howard

The University of Memphis | U of M · Department of Health and Sport Sciences

Primary central nervous system lymphoma (PCNSL) is a highly aggressive non-Hodgkin lymphoma that is confined within the CNS. Due to its ability to cross the blood–brain barrier, high-dose methotrexate (HDMTX) is the backbone for induction chemotherapy. This systematic review was conducted to observe outcomes among different HDMTX doses (low, <3 g/m...

Background: Children with relapsed acute lymphoblastic leukemia (ALL) in low-income and middle-income countries rarely survive. The Pediatric Hematology-Oncology Association of Central America (AHOPCA) developed the AHOPCA-ALL REC 2014 protocol to improve outcomes in resource-constrained settings without access to stem cell transplantation. Metho...

Aim: High-dose methotrexate (HDMTX) is an essential part of the treatment of several adult and pediatric malignancies. Despite meticulous supportive care during HDMTX administration, severe toxicities, including acute kidney injury (AKI), may occur contributing to patient morbidity. Population pharmacokinetics provide a powerful tool to predict ti...

Adverse reactions during and shortly after infusing asparaginase for the treatment of acute lymphoblastic leukemia can increase in severity with later doses, limiting further use and increasing relapse risk. Although asparaginase is associated with hyperammonemia, the magnitude of the increase in serum ammonia immediately after the infusion and in...

Executive Summary • Children with cancer in low-and middle-income countries (LMIC) succumb to their disease four times more often than those in high-income countries (HIC). 1 • Ninety percent of all pediatric cancers occur in LMIC. 2 • In HIC, more than 80% of children with cancer are cured, but in LMIC only 26% survive. 3 • Nurses play a vital rol...

PURPOSE Access to essential cancer medicines is a major determinant of childhood cancer outcomes globally. The degree to which pediatric oncologists deem medicines listed on WHO's Model List of Essential Medicines for Children (EMLc) essential is unknown, as is the extent to which such medicines are accessible on the front lines of clinical care....

Background When the COVID-19 case number reaches a maximum in a country, its capacity and management of health system face greatest challenge. Methods We performed a cross-sectional study on data of turning points for cases and deaths for the first three waves of COVID-19 in countries with more than 5000 cumulative cases, as reported by Worldomete...

Many studies have evaluated factors that influence the course of the COVID-19 pandemic in different countries. This multicountry study assessed the influence of democracy and other factors on the case fatality rate of COVID-19 during the early stage of the pandemic. We accessed the World Health Organization, World Bank, and the Democracy Index 2019...

Background: Tumor boards are part of standard care of patients with complex cancers, but appropriate multidisciplinary expertise and infrastructure are often not available in low- and middle-income countries (LMIC) for pediatric cancers, such as neuroblastoma. Our goal was to review results of a Global Neuroblastoma Network (GNN) tumor board acces...

Background: Genomic heterogeneity in leukemic blasts characterizes Acute Myeloid Leukemia (AML) patients and is associated to variable drug response. However, use of genomics to guide therapy has generally been restricted to a single-gene approach, which rarely has sufficient predictive power to be clinically useful. Comprehensive DNA sequencing an...

Introduction: Clinicians in academia face four major career challenges: Gaining clinical advice from colleagues experienced in a particular disease or treatment Experiencing Life-long coaching and mentoring from senior experienced clinicians Accessing high quality continuing medical education relevant for patient care Support to carry out medical r...

Background: The optimal treatment strategy for managing Acute Myeloid Leukemia (AML) and the use of reliable and predictive biomarkers to guide selection of cytotoxic chemotherapy regimens among patients with diverse genomic profiles remain unmet needs in the clinic. The combination of MEC [mitoxantrone (MIT), etoposide (VP16), and cytarabine (ARA-...

Background: DNA methyltransferase inhibition (DNMTi) with hypomethylating agents (HMA), azacitidine (AZA) or decitabine (DAC), remains the mainstay of therapy for most high-risk Myelodysplastic syndrome (MDS) patients. However, only 40-50% of MDS patients achieve clinical improvement with DNMTi. Previously, combinations of HMA and histone deacetyla...

Background: Mantle Cell Lymphoma (MCL) accounts for 3-10% of all non-Hodgkin lymphomas with a median overall survival of 3-4 years. Hyper-CVAD (CVAD) with or without Rituximab constitutes first line therapy for treatment of MCL, yet the use of this combination is associated with high toxicity and only modest efficacy. On the other hand, impressive...

Background: Although some genomic biomarkers have been integrated into therapeutic decision-making for the management of AML, the complete remission and cure rates have significant margin for improvement. Except for a few targeted therapies, genomic assessments offer limited guidance on treatment. Nevertheless, comprehensive molecular profiling of...

Background: DNA methyltransferase inhibition (DNMTi) with the hypomethylating agents (HMA) azacitidine (AZA) or decitabine, remains the mainstay of therapy for the majority of high-risk Myelodysplastic Syndromes (MDS) patients. Nevertheless, only 40-50% of MDS patients achieve clinical improvement with DNMTi. There is a need for a predictive clinic...

Data from the early stage of a novel infectious disease outbreak provide vital information in risk assessment, prediction, and precise disease management. Since the first reported case of COVID-19, the pattern of the novel coronavirus transmission in Wuhan has become the interest of researchers in epidemiology and public health. To thoroughly map t...

Introduction Inalignment with the World Health Organization (WHO) Global Initiative for Childhood Cancer (GICC), the International Society of Pediatric Oncology initiated a program to map global pediatric oncology services. As survival rates in Africa are low and data are scant, this continent was mapped first to identify areas with greatest need....

Whether smokers respond to anti-cancer drugs differently than non-smokers remains controversial. The objective of this study is to explore whether the better response of the smokers is specific to therapy of anti-PD-1/PD-L1, anti-checkpoint inhibitor, individual drugs on the cell surface, or lung cancer. Our results showed that among all non-small...

Purpose Computerised prescriber (or physician) order entry (CPOE) implementation is one of the strategies to reduce medication errors. The extent to which CPOE influences the incidence of chemotherapy-related medication errors (CMEs) was not previously collated and systematically reviewed. Hence, this study was designed to collect, collate, and sys...

In November 2018, theInternational Society of Paediatric Oncology (SIOP) launched a project to map African facilities providing pediatric oncology treatment. A 55‐item digital survey was created in English, piloted in India, translated to French and Portuguese, and distributed by email, social media, or personal contacts. December 2019, 48/54 Afric...

The complexity of COVID-19 and variations in control measures and containment efforts in different countries have caused difficulties in the prediction and modeling of the COVID-19 pandemic. We attempted to predict the scale of the latter half of the pandemic based on real data using the ratio between the early and latter halves from countries wher...

7027 Background: ATRA combined with arsenic trioxide revolutionized the treatment of APL. Based on promising in vitro data, several clinical trials evaluated ATRA combinations in non-APL AML, in which some patients seemed to benefit from the addition. Thus, predicting response a priori is imperative to determine the optimal treatment for each patie...

The COVID-19 pandemic poses an unprecedented health crisis in all socio-economic regions across the globe. While the pandemic has had a profound impact on access to and delivery of health care by all services, it has been particularly disruptive for the care of patients with life-threatening noncommunicable diseases (NCDs) such as the treatment of...

Studies of fluid secretion by the small intestine are dominated by the coupling with ATP-dependent generation of ion gradients, whereas the contribution of filtration secretion has been overlooked, possibly by the lack of a known mechanistic basis. We measured apical fluid flow and generation of hydrostatic pressure gradients by epithelia of cultur...

While countries are in a hurry to obtain SARS-CoV-2 vaccine, we are concerned with the availability of vaccine and whether a vaccine will be available to all in need. We predicted three possible scenarios for vaccine distributions and urge an international united action on the worldwide equitable access. In case the international community does not...

Aims Childhood cancer survival is suboptimal in most low- and middle-income countries (LMICs). Radiotherapy plays a significant role in the standard care of many patients. To assess the current status of paediatric radiotherapy, the International Atomic Energy Agency (IAEA) undertook a global survey and a review of practice in eight leading treatme...

Background:Early T-cell Precursor Acute Lymphoblastic Leukemia (ETP-ALL), an orphan disease, is a sub-type of T-Cell Acute Lymphoblastic Leukemia (T-ALL) with very poor prognosis and limited therapy options. ETP-ALL is a heterogeneous disease with many distinct genomic profiles, often with more myeloid than lymphoid characteristics. However, standa...

Background: Monosomy 7/Del 7 (-7) or its long arm (del(7q)) is one of the most common cytogenetic abnormalities in pediatric and adult myeloid malignancies, particularly in adverse-risk acute myeloid leukemias (AMLs). In general, (-7) is associated with poor response to induction chemotherapy (PMID 12393746). At the same time, not all patients fare...

Background: AML is a heterogeneous hematological cancer, characterized by the clonal expansion of myeloid blasts in the peripheral blood, bone marrow and other tissues. Among adults, AML is the leading cause of leukemia-associated death. Patients are often elderly and have comorbid conditions. Response to remission induction therapy varies by biolo...

Background: Acute promyelocytic leukemia (APL) is a biologically and clinically distinct subtype of acute myeloid leukemia (AML) with unique molecular pathogenesis, clinical manifestations, and treatment. APL is cytogenetically characterized by a balanced translocation t(15;17) (q24;q21), which involves the retinoic acid receptor alpha (RARA) gene...

Introduction Cervical cancer is controllable through appropriate interventions such as vaccination, screening, treatment, early diagnosis and palliative care. The greatest burden of cervical cancer lies in low-income countries (LIC) where most of these services are missing or developed asymmetrically. Indeed, it is important to have not just an exp...

17 Background: In Sri Lanka, children with acute lymphoblastic leukemia are treated on the UKALL 2011 protocol, which includes high-dose methotrexate (HDMTX) in high risk patients. Safe delivery of HDMTX is challenging in low resource settings, where deviation from accepted guidelines can occur frequently and result in toxicity, subsequent treatmen...

Severe blood disorders and cancer are the leading cause of death and disability from noncommunicable diseases in the global pediatric population and a major financial burden. The most frequent of these conditions, namely sickle cell disease and severe thalassemia, are highly curable by blood or bone marrow transplantation (BMT) which can restore a...

eCancer treatment in low- and middle-income countries (LMIC) differs substantially from that in high-income countries (HIC), and these differences are the focus of this chapter. In looking at these differences in cancer treatment, this chapter discusses healthcare disparities between LMIC and HIC, the importance of paediatric cancer units (PCU) (re...

Background: Cervical cancer is a preventable cancer; therefore, countries should provide strategic, evidence-based health services to reduce its incidence and impact on their populations. Two packages of health services that group together all the services related to cervical cancer, the Essential Cancer Package (9 interventions) and the Primary C...

In view of the fact that the 2019-nCoV has spread to most countries in the world, it is necessary to make scientific and well-founded predictions of the current pandemic situation caused by the virus worldwide, which are conducive to public, social and government responses that mitigate and appropriately address the pandemic. We collected data from...

Call for papers: Environmental Factors and the Epidemics of COVID-19

e14008 Background: Primary central nervous system lymphoma (PCNSL) can often be cured, especially in younger patients, but requires intense chemotherapy with high-dose methotrexate (HDMTX) and rituximab to optimize outcomes. Toxicities can lead to dose reduction or omission that may increase relapse risk, or lead clinicians to select less effective...

The global COVID-19 outbreak is worrisome both for its high rate of spread, and the high case fatality rate reported by early studies and now in Italy. We report a new methodology, the Patient Information Based Algorithm (PIBA), for estimating the death rate of a disease in real-time using publicly available data collected during an outbreak. PIBA...

The data of COVID-19 disease in China and then in South Korea were collected daily from several different official websites. The collected data included 33 death cases in Wuhan city of Hubei province during early outbreak as well as confirmed cases and death toll in some specific regions, which were chosen as representatives from the perspective of...

Drug repositioning offers an unmatched opportunity to offer novel therapeutics to treat SARS family of coronaviruses (SARS-FCoVs); an issue that became extremely urgent with the spreading of a novel virus with potential to threaten the lives of millions of people. Hereby, we analyzed a dataset of patients who presented with SARS during the 2003 out...

Objectives: A growing body of research has demonstrated the effect of local government spending on health outcomes; however, the effect of spending on different demographic groups is unclear. We combined national and local data to examine the impact of public spending on mortality rates in Tennessee. Methods: Within-between random effects models...

Terms used to label types of clinical recommendations and guidance are applied inconsistently and do not reflect the methods used to create each type. Here, the international Pediatric Oncology Supportive Care Guideline Network proposes a lexicon for types of recommendations and guidance documents. A lexicon describing three types of recommendation...

Tumor lysis syndrome can occur in any patient with newly diagnosed or relapsed cancer, so all patients should undergo risk stratification. Laboratory tumor lysis syndrome is the presence of two or more of the following abnormalities present on the same day: hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia because of hyperphosphatemi...

Background High-dose methotrexate (HDMTX, doses higher than 500 mg/m2) is an essential component of therapy for several hematologic cancers but requires meticulous supportive care and therapeutic drug monitoring to deliver safely. Community oncologists manage 85% of adults with cancer in the USA but may lack infrastructure to support HDMTX administ...

Background Tumor lysis syndrome (TLS) can complicate the management of patients with bulky chemosensitive cancers. TLS incidence and severity are increasing with new highly effective agents for hematologic cancers. However, prophylaxis and management vary widely, even within the same center. Methods We examined TLS management and outcomes from reco...

Background/Objectives: Most children with cancer in Africa go undiagnosed, and those diagnosed have significantly inferior chances of survival when compared to high-income countries. To complement the WHO’s mission to increase survival rates of children with cancer, this project creates a baseline of paediatric oncology resources across Africa. Des...

Purpose: In 2012, the French African Pediatric Oncology Group established the African School of Pediatric Oncology (EAOP), a training program supported by the Sanofi Espoir Foundation's My Child Matters program. As part of the EAOP, the pediatric oncology training diploma is a 1-year intensive training program. We present this training and certifi...

The 13th African continental meeting of the international society of paediatric oncology, held on 6-9 March 2019 in Cairo, was organised in collaboration with the Children Cancer Hospital (57357) in Egypt and the global parents' organisation (Childhood Cancer International) and supported by a large international faculty. With 629 delegates from 37...

6571 Background: Causes of drug shortages in low-income and middle-income countries are numerous and often more than one cause contributes. Shortages are especially problematic when they involve drugs like high-dose methotrexate (HDMTX), which is required for several highly curable cancers and has no good substitute. Morocco is currently experienci...

e18559 Background: TLS complicates management of bulky chemosensitive cancers. Incidence and severity have increased with new, effective therapies. Prophylaxis/management vary widely. We assessed impact of RAS on outcomes of pts at risk for TLS. Methods: We examined medical records of 5860 pts newly diagnosed with hematologic cancers treated in 101...

The 13th African continental meeting of the international society of paediatric oncology, held on 6-9 March 2019 in Cairo, was organised in collaboration with the Children Cancer Hospital (57357) in Egypt and the global parents' organisation (Childhood Cancer International) and supported by a large international faculty. With 629 delegates from 37...

Each year ~429,000 children and adolescents aged 0 to 19 years are expected to develop cancer. Five-year survival rates exceed 80% for the 45,000 children with cancer in high-income countries (HICs) but are less than 30% for the 384,000 children in lower-middle-income countries (LMICs). Improved survival rates in HICs have been achieved through mul...

Background: Traumatic and bloody lumbar punctures (TLPs and BLPs, respectively) at the diagnosis of pediatric acute lymphoblastic leukemia (ALL) impair the interpretation of central nervous system status and are associated with worse outcomes. We previously analyzed risk factors for TLP and BLP in 958 patients with ALL treated at St. Jude Children'...

Growth after preterm birth is an important determinant of long-term outcomes. Yet, many preterm infants suffer ex utero growth retardation. We evaluated effects of leucine and the metabolite, β-hydroxy β-methylbutyrate (HMB) on growth of preterm pigs, a previously-validated translational model for preterm infants. After 48 h of parenteral nutrition...

In low-income and middle-income countries, an excess in treatment failure for children with cancer usually results from misdiagnosis, inadequate access to treatment, death from toxicity, treatment abandonment, and relapse. The My Child Matters programme of the Sanofi Espoir Foundation has funded 55 paediatric cancer projects in low-income and middl...

In low-income and middle-income countries, an excess in treatment failure for children with cancer usually results from misdiagnosis, inadequate access to treatment, death from toxicity, treatment abandonment, and relapse. The My Child Matters programme of the Sanofi Espoir Foundation has funded 55 paediatric cancer projects in low-income and middl...

Objective: To synthesize peer-reviewed knowledge on the frequency of different types of chemotherapy medication errors. Methods: The data were collected from studies published between January 1, 2000, and March 3, 2018, and are identified through online resources such as Medline/PubMed, PubMed Central, Agency for Healthcare Research, and Quality an...

Background Previous research developed a new method for locating prescribing errors in rapidly discontinued electronic medication orders. Although effective, the prospective design of that research hinders its feasibility for regular use. Objectives Our objectives were to assess a method to retrospectively detect prescribing errors, to characterize...

Objective: To synthesize peer‑reviewed knowledge on the frequency of different types of chemotherapy medication errors. Methods: The data were collected from studies published between January 1, 2000, and March 3, 2018, and are identified through online resources such as Medline/PubMed, PubMed Central, Agency for Healthcare Research, and Quality an...