Pakistan National Guidelines for Pediatric High-Grade Gliomas

  • Farrah Bashir AKUH
  • Bilal Mazhar Qureshi
  • Khurram Minhas
  • Uri Tabori
  • Eric Bouffet
  • Cynthia Hawkins
  • Ather Enam
  • Naureen Mushtaq
Keywords: central nervous system tumor, mismatch repair genes PMS2, temozolomide, germline mutation, guidelines


Pediatric high-grade glioma (pHGG) is highly malignant central nervous system tumor and constitute 10% of the pediatric gliomas. Effective treatment needs a functioning multi-disciplinary team including pediatric neuro oncologist, neurosurgeon, neuroradiologist, neuropathologist and radiation oncologist. Despite surgical resection, radiotherapy and chemotherapy, most HGG will recur resulting in early death. A significant proportion of HGG occurs in context of cancer predisposition syndromes like Constitutional Mismatch Repair Deficiency (CMMRD) also known as Biallelic Mismatch Repair Deficiency (bMMRD) characterized by high mutational burden. The incidence of HGG with CMMRD is one per million patients. bMMRD is caused by homozygous germline mutations in one of the four Mis Match Repair (MMR) genes (PMS2, MLH1, MSH2, and MSH6). The use of TMZ is now avoided in CMMRD related HGG due to its limited response and known ability to increase the accumulation of somatic mutations in these patients, increasing the risk of secondary tumors. HGG should be managed under the care of multidisciplinary team to receive optimum treatment. This is particularly important for low middle-income countries (LMIC) with limited resources like Pakistan.


How to cite this: Bashir F, Qureshi BM, Minhas K, Tabori U, Bouffet E, Hawkins C, et al. Pakistan National Guidelines for Pediatric High-Grade Gliomas. Pak J Med Sci. 2023;39(5):1548-1554. doi:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to Cite
Bashir, F., Qureshi, B. M., Minhas, K., Tabori, U., Bouffet, E., Hawkins, C., Enam, A., & Mushtaq, N. (2023). Pakistan National Guidelines for Pediatric High-Grade Gliomas. Pakistan Journal of Medical Sciences, 39(5).