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Farrag A, Ghazaly MH, Mohammed K, Volland R, Hero B, Berthold F. Comparing presentations and outcomes of children with cancer: a study between a lower-middle-income country and a high-income country. BMC Pediatr 2023; 23:443. [PMID: 37670249 PMCID: PMC10478379 DOI: 10.1186/s12887-023-04214-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/26/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Substantial progress has been achieved in managing childhood cancers in many high-income countries (HICs). In contrast, survival rates in lower-middle-income countries (LMICs) are less favorable. Here, we aimed to compare outcomes and associated factors between two large institutions; Egypt (LMIC) and Germany (HIC). METHODS A retrospective review was conducted on newly diagnosed children with cancer between 2006 and 2010 in the departments of pediatric oncology at the South Egypt Cancer Institute (SECI) (n = 502) and the University Hospital of Cologne-Uniklinik Köln (UKK) (n = 238). Characteristics including age, sex, diagnosis, travel time from home to the cancer center, the time interval from initial symptoms to the start of treatment, treatment-related complications, compliance, and outcome were analyzed. A Cox proportional hazards regression model was applied to investigate the influence of risk factors. RESULTS The most common diagnoses in SECI were leukemia (48.8%), lymphomas (24.1%), brain tumors (1%), and other solid tumors (24.7%), compared to 22.3%, 19.3%, 28.6%, and 26.5% in UKK, respectively. Patients from SECI were younger (5.2 vs. 9.0 years, P < 0.001), needed longer travel time to reach the treatment center (1.44 ± 0.07 vs. 0.53 ± 0.03 h, P < 0.001), received therapy earlier (7.53 ± 0.59 vs. 12.09 ± 1.01 days, P = 0.034), showed less compliance (85.1% vs. 97.1%, P < 0.001), and relapsed earlier (7 vs. 12 months, P = 0.008). Deaths in SECI were more frequent (47.4% vs. 18.1%) and caused mainly by infection (60% in SECI, 7% in UKK), while in UKK, they were primarily disease-related (79% in UKK, 27.7% in SECI). Differences in overall and event-free survival were observed for leukemias but not for non-Hodgkin lymphoma. CONCLUSIONS Outcome differences were associated with different causes of death and other less prominent factors.
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Affiliation(s)
- Ahmed Farrag
- Department of Pediatric Oncology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, University Hospital of Cologne, Cologne, Germany.
| | | | - Khaled Mohammed
- Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ruth Volland
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Statistics, University Hospital of Cologne, Cologne, Germany
| | - Barbara Hero
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, University Hospital of Cologne, Cologne, Germany
| | - Frank Berthold
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, University Hospital of Cologne, Cologne, Germany
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Mehta NP, Sawdy R, Maloney K, Overlee B, Johnson RK, Howe CL, Farias-Moeller R. Intrathecal Dexamethasone in Febrile Infection-Related Epilepsy Syndrome: A Case Report. Neurol Clin Pract 2023; 13:e200153. [PMID: 37197372 PMCID: PMC10184555 DOI: 10.1212/cpj.0000000000200153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 02/15/2023] [Indexed: 05/19/2023]
Abstract
Objectives Febrile infection-related epilepsy syndrome (FIRES) is characterized by explosive onset refractory status epilepticus (RSE) in healthy individuals that is refractory to antiseizure medication (ASM), continuous anesthetic infusions (CIs), and immunomodulators. Recently, a case series of patients receiving intrathecal dexamethasone (IT-DEX) was reported with improved RSE control. Methods We present a child with FIRES with favorable outcome after receiving concomitant anakinra and IT-DaEX. A 9-year-old male patient presented with encephalopathy following a febrile illness. He developed seizures evolving to RSE refractory to multiple ASM, 3 CIs, steroids, IVIG, plasmapheresis, ketogenic diet (KD), and anakinra. After continued seizures and inability to wean off CI, IT-DEX was initiated. Results He received 6 doses of IT-DEX with resolution of RSE, rapid wean off CI, and improved inflammatory markers. At discharge, he was ambulating with assistance, speaking 2 languages, and ingesting food orally. Discussion FIRES is a neurologically devastating syndrome with high mortality and morbidity. Proposed guidelines and various treatment strategies are becoming available in the literature. Although treatment with KD, anakinra, and tocilizumab has been successful in previous FIRES cases, our results suggest that the addition of IT-DEX may allow for faster weaning off CI and better cognitive outcomes when initiated early in the course.
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Affiliation(s)
- Niyati P Mehta
- Departments of Neurology (NPM, RS, RF-M) and Pediatrics (KM, RF-M), Medical College of Wisconsin, Milwaukee; Translational Neuroimmunology Lab (BO, RKJ, CLH) and Department of Neurology (BO, RKJ, CLH), Mayo Clinic, Rochester, MN
| | - Rachel Sawdy
- Departments of Neurology (NPM, RS, RF-M) and Pediatrics (KM, RF-M), Medical College of Wisconsin, Milwaukee; Translational Neuroimmunology Lab (BO, RKJ, CLH) and Department of Neurology (BO, RKJ, CLH), Mayo Clinic, Rochester, MN
| | - Kathleen Maloney
- Departments of Neurology (NPM, RS, RF-M) and Pediatrics (KM, RF-M), Medical College of Wisconsin, Milwaukee; Translational Neuroimmunology Lab (BO, RKJ, CLH) and Department of Neurology (BO, RKJ, CLH), Mayo Clinic, Rochester, MN
| | - Brittany Overlee
- Departments of Neurology (NPM, RS, RF-M) and Pediatrics (KM, RF-M), Medical College of Wisconsin, Milwaukee; Translational Neuroimmunology Lab (BO, RKJ, CLH) and Department of Neurology (BO, RKJ, CLH), Mayo Clinic, Rochester, MN
| | - Renee K Johnson
- Departments of Neurology (NPM, RS, RF-M) and Pediatrics (KM, RF-M), Medical College of Wisconsin, Milwaukee; Translational Neuroimmunology Lab (BO, RKJ, CLH) and Department of Neurology (BO, RKJ, CLH), Mayo Clinic, Rochester, MN
| | - Charles L Howe
- Departments of Neurology (NPM, RS, RF-M) and Pediatrics (KM, RF-M), Medical College of Wisconsin, Milwaukee; Translational Neuroimmunology Lab (BO, RKJ, CLH) and Department of Neurology (BO, RKJ, CLH), Mayo Clinic, Rochester, MN
| | - Raquel Farias-Moeller
- Departments of Neurology (NPM, RS, RF-M) and Pediatrics (KM, RF-M), Medical College of Wisconsin, Milwaukee; Translational Neuroimmunology Lab (BO, RKJ, CLH) and Department of Neurology (BO, RKJ, CLH), Mayo Clinic, Rochester, MN
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Treatment of Ph-Negative Acute Lymphoblastic Leukemia in Adolescents and Young Adults with an Affordable Outpatient Pediatric Regimen. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:883-893. [PMID: 36057522 DOI: 10.1016/j.clml.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND B-cell acute lymphoblastic leukemia is frequent in Hispanic adolescents and young adults. Outcomes of implementation of pediatric-inspired regimens in low-and middle-income countries are not well known. METHODS In this study we treated 94 adolescents and young adults with a local BFM regimen designed to be affordable with the use of native L-asparaginase and mitoxantrone administered in an outpatient fashion, and the of BCR/ABL and measurable residual disease (MRD) determined by high sensitivity flow cytometry for risk stratification. RESULTS Induction mortality was 11%; 25% of patients had to abandon treatment or be transferred to another health system. Two-year overall (OS) and event free survival (EFS) were 61.5% and 49.8%, MRD-negative patients had a 24-month OS of 85.6% vs. 69.6% (p = .024) and EFS of 76% vs. 45.5% (p = .004). Patients older than 40 years and those who abandoned treatment had worse EFS. Overall drug costs in our regimen were 52% lower than those of CALGB10403. CONCLUSION The treatment of AYAs with ALL with an outpatient focus was implemented successfully at a reduced cost. Genetic risk assessment, treatment abandonment and lack of access to novel therapies remain major barriers for improving outcomes.
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Biondi A, Conter V, Chandy M, Ewald P, Lucia de Martino Lee M, Radhakrishnan VS, Rotchanapanya W, Scanlan P, Patrick Smith O, Togo B, Hokland P. Precursor B-cell acute lymphoblastic leukaemia-a global view. Br J Haematol 2021; 196:530-547. [PMID: 34931311 PMCID: PMC9300129 DOI: 10.1111/bjh.17959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/28/2021] [Accepted: 10/31/2021] [Indexed: 12/30/2022]
Abstract
As haematologists, we always seek to follow standardised guidelines for practice and apply the best treatment within our means for our patients with blood diseases. However, treatment can never follow an exact recipe. Opinions differ as to the best approach; sometimes more than one treatment approach results in identical outcomes, or treatments differ only by the manner in which they fail. Furthermore, the haematologist is faced with constraints relating to the local economic environment. Patients too are not the same the world over. Early presentation is commoner in the developed world, as is the patient’s understanding of the disease process. This in turn has an impact on the way patients are managed, the rigorousness of patient adhesion to the treatment schedule and the outcome. Here we take a look at the precursor B‐cell acute lymphoblastic leukaemia in an adolescent in a range of different settings from low‐ to high income countries with widely differing challenges for diagnosis, therpy and follow‐up. For these reasons, given the same starting conditions, patients will be treated differently according to the institute and the country they are in. Experts from around the world have been tasked to describe their management plan and rationale for a specific disease presentation. Here they explore the management of precursor B‐cell acute lymphoblastic leukaemia (pre‐B ALL) in five different institutions worldwide with a focus on those with more or less strained economies. We end with a conclusion from an expert in the field comparing and contrasting these different management styles and considering their merits and limitations.
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Affiliation(s)
- Andrea Biondi
- Clinica Pediatrica, Fondazione MBBM, Università Milano Bicocca, Ospedale San Gerardo, Monza, Italy
| | - Valentino Conter
- Clinica Pediatrica, Fondazione MBBM, Università Milano Bicocca, Ospedale San Gerardo, Monza, Italy
| | - Mammen Chandy
- Department of Clinical Haematology Oncology and HCT, Tata Medical Center, Kolkata, India
| | - Primus Ewald
- Muhimbili National Hospital and Tumaini la Maisha Children's Cancer Charity, Dar es Salaam, Tanzania
| | | | - Vivek S Radhakrishnan
- Department of Clinical Haematology Oncology and HCT, Tata Medical Center, Kolkata, India
| | - Wannaphorn Rotchanapanya
- Division of Hematology, Department of Medicine, Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
| | - Patricia Scanlan
- Muhimbili National Hospital and Tumaini la Maisha Children's Cancer Charity, Dar es Salaam, Tanzania
| | - Owen Patrick Smith
- Department of Paediatric and Adolescent Medicine, University College Dublin, Dublin, Ireland
| | - Boubacar Togo
- Department of Pediatrics, CHU Gabriel Touré, Bamako, Mali
| | - Peter Hokland
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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Al-Hadad SA, Al-Jadiry MF, Ghali HH, Al-Badri SAF, Al-Saeed RM, Al-Darraji AF, Sabhan AH, Fadhil SA, Hussein HM, Abed WM, Ameen NA, Sahan JKA, Jaafar GQ, Abed AR, Mohamed S, Moleti ML, Piciocchi A, Foà R, Testi AM. Treatment of childhood acute lymphoblastic leukemia in Iraq: a 17-year experience from a single center. Leuk Lymphoma 2021; 62:3430-3439. [PMID: 34355644 DOI: 10.1080/10428194.2021.1961237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We performed a retrospective analysis of 1415 acute lymphoblastic leukemia children diagnosed between January 2000 and December 2016 at Children Welfare Teaching Hospital, Baghdad, Iraq. Patients were divided into three cohorts according to treatment period (2000-2005; 2006-2011; 2012-2016). Treatments were based on modified-UKALL protocols; a steroid-pre-phase was introduced from September 2008. The overall complete remission was 86%, increased from 80% to 91% in the last period. Early deaths occurred in 10%, decreasing to 6%, overtime. Relapses were 23%; toxic deaths and abandonment 8% and 13%, respectively. At a median follow-up of 65.3 months, with abandonment considered as an event, the 5-year overall survival (OS) and event-free survival were 62.2% and 46.3%, statistically influenced by treatment period (5-year OS 62.6%, 59.1%, 66.3%; p=.057, respectively). Though pediatric ALL survival in Iraq is still below that observed in high income countries, survival rates progressively improved. Toxic deaths remain an important cause of failure.
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Affiliation(s)
- Salma Abbas Al-Hadad
- Department of Pediatrics, College of Medicine, University of Baghdad, Oncology Unit-Children Welfare Teaching Hospital-Medical City, Baghdad, Iraq
| | - Mazin Faisal Al-Jadiry
- Department of Pediatrics, College of Medicine, University of Baghdad, Oncology Unit-Children Welfare Teaching Hospital-Medical City, Baghdad, Iraq
| | - Hasanein Habeeb Ghali
- Department of Pediatrics, College of Medicine, University of Baghdad, Oncology Unit-Children Welfare Teaching Hospital-Medical City, Baghdad, Iraq
| | - Safaa A Faraj Al-Badri
- Department of Pediatrics, College of Medicine, University of Baghdad, Oncology Unit-Children Welfare Teaching Hospital-Medical City, Baghdad, Iraq
| | | | | | - Ahmed Hatem Sabhan
- Oncology Unit, Children Welfare Teaching Hospital-Medical City, Baghdad, Iraq
| | | | | | - Wisam Majeed Abed
- Hematology Laboratory Department, Children Welfare Teaching Hospital-Medical City, Baghdad, Iraq
| | - Najiha Ahmed Ameen
- Hematology Laboratory Department, Children Welfare Teaching Hospital-Medical City, Baghdad, Iraq
| | | | | | - Aseel Rashid Abed
- Oncology Unit, Children Welfare Teaching Hospital-Medical City, Baghdad, Iraq
| | - Sara Mohamed
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Maria Luisa Moleti
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | | | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Anna Maria Testi
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
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Bressan S, Da Dalt L, Chamorro M, Abarca R, Azzolina D, Gregori D, Sereni F, Montini G, Tognoni G. Paediatric emergencies and related mortality in Nicaragua: results from a multi-site paediatric emergency registry. Emerg Med J 2020; 38:338-344. [PMID: 33355304 DOI: 10.1136/emermed-2019-209324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 11/13/2020] [Accepted: 11/15/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND We aim to describe the characteristics and outcomes of the severe spectrum of paediatric emergency visits using a multi-site registry developed as part of an international cooperation project. METHODS This observational registry-based study presented descriptive statistics of clinical and outcome data on urgent-emergency paediatric visits from 7 Nicaraguan hospitals, including the national referral paediatric hospital, between January and December 2017. Extensive piloting to ensure data collection feasibility, sustainability and accuracy was carried out in 2016 with substantial input and feedback from local stakeholders. RESULTS Overall, 3521 visits of patients <15 years of age, of whom two-thirds <5 years, met predefined inclusion criteria of urgent-emergency visits. Respiratory (1619/3498; 46%), gastrointestinal (407/3498; 12%) and neurological (368/3498; 11%) complaints were the most common symptoms. Malnutrition was reported in 18% (610/3448) of presentations. Mortality was 7% (233/3521); 52% (120/233) of deaths occurred in the <1-year subgroup; 32% (71/3521) of deaths occurred within the first 24 hours of presentation. The most common immediate causes of death were septic shock (99/233; 43%), respiratory failure (58/233; 25%) and raised intracranial pressure (24/233; 10%). CONCLUSIONS The mortality rate of urgent-emergency paediatric visits in Nicaragua is high, with younger children being most at risk and the majority of deaths being eventually caused by septic shock or respiratory failure. Our data provide useful information for the development of a Paediatric Emergency Care network to help direct training efforts, resources and logistic/organisational interventions to improve children's health in an emergency setting in Nicaragua.
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Affiliation(s)
- Silvia Bressan
- Division of Paediatric Emergency Medicine - Department of Women's and Child's Health, Università degli Studi di Padova, Padova, Veneto, Italy
| | - Liviana Da Dalt
- Division of Paediatric Emergency Medicine - Department of Women's and Child's Health, Università degli Studi di Padova, Padova, Veneto, Italy
| | - Miriam Chamorro
- Department of Pediatric Emergency Medicine, Hospital Infantil La Mascota, Managua, Nicaragua
| | - Raquel Abarca
- Department of Pediatric Emergency Medicine, Hospital Infantil La Mascota, Managua, Nicaragua
| | - Danila Azzolina
- Unit of Biostatistics, Epidemiology and Public Health - Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Università degli Studi di Padova, Padova, Veneto, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health - Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Università degli Studi di Padova, Padova, Veneto, Italy
| | - Fabio Sereni
- Paediatric Nephrology, Dialysis and Transplant Unit- Department of Pediatrics, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico and Universita degli Studi di Milano, Milano, Lombardia, Italy
| | - Giovanni Montini
- Paediatric Nephrology, Dialysis and Transplant Unit- Department of Pediatrics, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico and Universita degli Studi di Milano, Milano, Lombardia, Italy
| | - Gianni Tognoni
- Departement of Anesthesia, Critical care, Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano Policlinico, Milan, Lombardy, Italy
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Ramirez O, Aristizabal P, Zaidi A, Ribeiro RC, Bravo LE. Implementing a Childhood Cancer Outcomes Surveillance System Within a Population-Based Cancer Registry. J Glob Oncol 2019; 4:1-11. [PMID: 30241253 PMCID: PMC6223468 DOI: 10.1200/jgo.17.00193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Approximately 80% of cases of childhood cancer occur in low- and middle-income countries and are associated with high mortality rates. Assessing outcomes is essential for designing effective strategies to improve outcomes equally worldwide. We implemented a real-time surveillance system, VIGICANCER, embedded in a population-based cancer registry (PBCR) to assess childhood cancer outcomes. Methods VIGICANCER was established in 2009 as an integral part of Cali’s PBCR to collect real-time data on outcomes of patients (age < 19 years) with a new diagnosis of cancer treated in pediatric oncology units in Cali, Colombia. Baseline and follow-up data (death, relapse, treatment abandonment, second neoplasms) were collected from medical records, hospital discharge logs, pathology reports, death certificates, and the National Public Health Insurance database. A quality assurance process was implemented for the system. Results From 2009 to 2013, data from 1,242 patients were included in VIGICANCER: 32% of patients were younger than 5 years, 55% were male, and 15% were Afro-descendants. International Classification of Childhood Cancer group I diagnoses predominated in all age groups except children younger than 1 year old, in whom CNS tumors predominated. Five-year overall survival for all cancers was 51.7% (95% CI, 47.9% to 55.4%) for children (< 15 years), and 39.4% (95% CI, 29.8% to 50.5%) for adolescents (15 to 18.9 years). Five-year overall survival for acute lymphoblastic leukemia was 55.6% (95% CI, 48.5% to 62.2%). Conclusion Our study demonstrates the feasibility of implementing a real-time childhood cancer outcomes surveillance system embedded in a PBCR that can guide interventions to improve clinical outcomes in low- and middle-income countries.
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Affiliation(s)
- Oscar Ramirez
- Oscar Ramirez and Luis E. Bravo, Universidad del Valle; Oscar Ramirez, POHEMA (Pediatric Oncologist and Hemotologist) Foundation, and Centro Médico Imbanaco, Cali, Colombia; Paula Aristizabal, University of California San Diego/Peckham Center for Cancer and Blood Disorders, Rady Children's Hospital, San Diego, and University of California San Diego Moores Cancer Center, La Jolla, CA; and Alia Zaidi and Raul C. Ribeiro, St Jude Children's Research Hospital, Memphis, TN
| | - Paula Aristizabal
- Oscar Ramirez and Luis E. Bravo, Universidad del Valle; Oscar Ramirez, POHEMA (Pediatric Oncologist and Hemotologist) Foundation, and Centro Médico Imbanaco, Cali, Colombia; Paula Aristizabal, University of California San Diego/Peckham Center for Cancer and Blood Disorders, Rady Children's Hospital, San Diego, and University of California San Diego Moores Cancer Center, La Jolla, CA; and Alia Zaidi and Raul C. Ribeiro, St Jude Children's Research Hospital, Memphis, TN
| | - Alia Zaidi
- Oscar Ramirez and Luis E. Bravo, Universidad del Valle; Oscar Ramirez, POHEMA (Pediatric Oncologist and Hemotologist) Foundation, and Centro Médico Imbanaco, Cali, Colombia; Paula Aristizabal, University of California San Diego/Peckham Center for Cancer and Blood Disorders, Rady Children's Hospital, San Diego, and University of California San Diego Moores Cancer Center, La Jolla, CA; and Alia Zaidi and Raul C. Ribeiro, St Jude Children's Research Hospital, Memphis, TN
| | - Raul C Ribeiro
- Oscar Ramirez and Luis E. Bravo, Universidad del Valle; Oscar Ramirez, POHEMA (Pediatric Oncologist and Hemotologist) Foundation, and Centro Médico Imbanaco, Cali, Colombia; Paula Aristizabal, University of California San Diego/Peckham Center for Cancer and Blood Disorders, Rady Children's Hospital, San Diego, and University of California San Diego Moores Cancer Center, La Jolla, CA; and Alia Zaidi and Raul C. Ribeiro, St Jude Children's Research Hospital, Memphis, TN
| | - Luis E Bravo
- Oscar Ramirez and Luis E. Bravo, Universidad del Valle; Oscar Ramirez, POHEMA (Pediatric Oncologist and Hemotologist) Foundation, and Centro Médico Imbanaco, Cali, Colombia; Paula Aristizabal, University of California San Diego/Peckham Center for Cancer and Blood Disorders, Rady Children's Hospital, San Diego, and University of California San Diego Moores Cancer Center, La Jolla, CA; and Alia Zaidi and Raul C. Ribeiro, St Jude Children's Research Hospital, Memphis, TN
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8
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Piñeros M, Frech S, Frazier L, Laversanne M, Barnoya J, Garrido C, Gharzouzi E, Chacón A, Fuentes Alabi S, Ruiz de Campos L, Figueroa J, Dominguez R, Rojas O, Pereira R, Rivera C, Morgan DR. Advancing Reliable Data for Cancer Control in the Central America Four Region. J Glob Oncol 2018; 4:1-11. [PMID: 30241165 PMCID: PMC6180802 DOI: 10.1200/jgo.2016.008227] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The Central America Four (CA-4) region, comprising Guatemala, Honduras, El Salvador, and Nicaragua, is the largest low- and middle-income country region in the Western Hemisphere, with over 36 million inhabitants. The CA-4 nations share a common geography, history, language, and development indices, and unified with open borders in 2006. The growing CA-4 cancer burden among the noncommunicable diseases is expected to increase 73% by 2030, which argues for a regional approach to cancer control. This has driven efforts to establish population-based cancer registries as a central component of the cancer control plans. The involvement of international and academic partners in an array of initiatives to improve cancer information and control in the CA-4 has accelerated over the past several years. Existing data underscore that the infectious cancers (cervical, stomach, and liver) are a particular burden. All four countries have committed to establishing regional population-based cancer registries and have advanced significantly in pediatric cancer registration. The challenges common to each nation include the lack of national cancer control plans and departments, competing health priorities, lack of trained personnel, and sustainability strategies. General recommendations to address these challenges are outlined. The ongoing regional, international, and academic cooperation has proven helpful and is expected to continue to be a powerful instrument to contribute to the design and implementation of long-term national cancer control plans.
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Affiliation(s)
- Marion Piñeros
- Marion Piñeros and Mathieu Laversanne,
International Agency for Research on Cancer, Lyon, France; Silvina
Frech, US National Cancer Institute, Bethesda, MD; Lindsay
Frazier, Dana-Farber/Children’s Cancer Center, Boston MA;
Joaquin Barnoya and Eduardo Gharzouzi, Instituto
de Cancerologia; Claudia Garrido, Unidad Nacional Oncología
Pediátrica, Guatemala City, Guatemala; Joaquin Barnoya,
Washington University in St. Louis, St. Louis, MO; Andrea
Chacón, Unidad Nacional para la Prevención y control del
Cáncer, Ministerio de Salud; Soad Fuentes Alabi, Hospital
Benjamín Bloom, Ministerio de Salud; Lisseth Ruiz de Campos,
Asociación Salvadoreña para la Prevención del Cáncer, San
Salvador, El Salvador; Jacqueline Figueroa, Unidad de Registro de
Cáncer, Secretaria de Salud, Tegucigalpa; Ricardo Dominguez,
Hospital de Occidente, Secretaria de Salud, Copán, Honduras; Ofelia
Rojas, Rosario Pereira, and Carla Rivera,
Universidad Nacional Autónoma de Nicaragua, León, Nicaragua; and
Douglas R. Morgan, Vanderbilt University, Nashville, TN
| | - Silvina Frech
- Marion Piñeros and Mathieu Laversanne,
International Agency for Research on Cancer, Lyon, France; Silvina
Frech, US National Cancer Institute, Bethesda, MD; Lindsay
Frazier, Dana-Farber/Children’s Cancer Center, Boston MA;
Joaquin Barnoya and Eduardo Gharzouzi, Instituto
de Cancerologia; Claudia Garrido, Unidad Nacional Oncología
Pediátrica, Guatemala City, Guatemala; Joaquin Barnoya,
Washington University in St. Louis, St. Louis, MO; Andrea
Chacón, Unidad Nacional para la Prevención y control del
Cáncer, Ministerio de Salud; Soad Fuentes Alabi, Hospital
Benjamín Bloom, Ministerio de Salud; Lisseth Ruiz de Campos,
Asociación Salvadoreña para la Prevención del Cáncer, San
Salvador, El Salvador; Jacqueline Figueroa, Unidad de Registro de
Cáncer, Secretaria de Salud, Tegucigalpa; Ricardo Dominguez,
Hospital de Occidente, Secretaria de Salud, Copán, Honduras; Ofelia
Rojas, Rosario Pereira, and Carla Rivera,
Universidad Nacional Autónoma de Nicaragua, León, Nicaragua; and
Douglas R. Morgan, Vanderbilt University, Nashville, TN
| | - Lindsay Frazier
- Marion Piñeros and Mathieu Laversanne,
International Agency for Research on Cancer, Lyon, France; Silvina
Frech, US National Cancer Institute, Bethesda, MD; Lindsay
Frazier, Dana-Farber/Children’s Cancer Center, Boston MA;
Joaquin Barnoya and Eduardo Gharzouzi, Instituto
de Cancerologia; Claudia Garrido, Unidad Nacional Oncología
Pediátrica, Guatemala City, Guatemala; Joaquin Barnoya,
Washington University in St. Louis, St. Louis, MO; Andrea
Chacón, Unidad Nacional para la Prevención y control del
Cáncer, Ministerio de Salud; Soad Fuentes Alabi, Hospital
Benjamín Bloom, Ministerio de Salud; Lisseth Ruiz de Campos,
Asociación Salvadoreña para la Prevención del Cáncer, San
Salvador, El Salvador; Jacqueline Figueroa, Unidad de Registro de
Cáncer, Secretaria de Salud, Tegucigalpa; Ricardo Dominguez,
Hospital de Occidente, Secretaria de Salud, Copán, Honduras; Ofelia
Rojas, Rosario Pereira, and Carla Rivera,
Universidad Nacional Autónoma de Nicaragua, León, Nicaragua; and
Douglas R. Morgan, Vanderbilt University, Nashville, TN
| | - Mathieu Laversanne
- Marion Piñeros and Mathieu Laversanne,
International Agency for Research on Cancer, Lyon, France; Silvina
Frech, US National Cancer Institute, Bethesda, MD; Lindsay
Frazier, Dana-Farber/Children’s Cancer Center, Boston MA;
Joaquin Barnoya and Eduardo Gharzouzi, Instituto
de Cancerologia; Claudia Garrido, Unidad Nacional Oncología
Pediátrica, Guatemala City, Guatemala; Joaquin Barnoya,
Washington University in St. Louis, St. Louis, MO; Andrea
Chacón, Unidad Nacional para la Prevención y control del
Cáncer, Ministerio de Salud; Soad Fuentes Alabi, Hospital
Benjamín Bloom, Ministerio de Salud; Lisseth Ruiz de Campos,
Asociación Salvadoreña para la Prevención del Cáncer, San
Salvador, El Salvador; Jacqueline Figueroa, Unidad de Registro de
Cáncer, Secretaria de Salud, Tegucigalpa; Ricardo Dominguez,
Hospital de Occidente, Secretaria de Salud, Copán, Honduras; Ofelia
Rojas, Rosario Pereira, and Carla Rivera,
Universidad Nacional Autónoma de Nicaragua, León, Nicaragua; and
Douglas R. Morgan, Vanderbilt University, Nashville, TN
| | - Joaquin Barnoya
- Marion Piñeros and Mathieu Laversanne,
International Agency for Research on Cancer, Lyon, France; Silvina
Frech, US National Cancer Institute, Bethesda, MD; Lindsay
Frazier, Dana-Farber/Children’s Cancer Center, Boston MA;
Joaquin Barnoya and Eduardo Gharzouzi, Instituto
de Cancerologia; Claudia Garrido, Unidad Nacional Oncología
Pediátrica, Guatemala City, Guatemala; Joaquin Barnoya,
Washington University in St. Louis, St. Louis, MO; Andrea
Chacón, Unidad Nacional para la Prevención y control del
Cáncer, Ministerio de Salud; Soad Fuentes Alabi, Hospital
Benjamín Bloom, Ministerio de Salud; Lisseth Ruiz de Campos,
Asociación Salvadoreña para la Prevención del Cáncer, San
Salvador, El Salvador; Jacqueline Figueroa, Unidad de Registro de
Cáncer, Secretaria de Salud, Tegucigalpa; Ricardo Dominguez,
Hospital de Occidente, Secretaria de Salud, Copán, Honduras; Ofelia
Rojas, Rosario Pereira, and Carla Rivera,
Universidad Nacional Autónoma de Nicaragua, León, Nicaragua; and
Douglas R. Morgan, Vanderbilt University, Nashville, TN
| | - Claudia Garrido
- Marion Piñeros and Mathieu Laversanne,
International Agency for Research on Cancer, Lyon, France; Silvina
Frech, US National Cancer Institute, Bethesda, MD; Lindsay
Frazier, Dana-Farber/Children’s Cancer Center, Boston MA;
Joaquin Barnoya and Eduardo Gharzouzi, Instituto
de Cancerologia; Claudia Garrido, Unidad Nacional Oncología
Pediátrica, Guatemala City, Guatemala; Joaquin Barnoya,
Washington University in St. Louis, St. Louis, MO; Andrea
Chacón, Unidad Nacional para la Prevención y control del
Cáncer, Ministerio de Salud; Soad Fuentes Alabi, Hospital
Benjamín Bloom, Ministerio de Salud; Lisseth Ruiz de Campos,
Asociación Salvadoreña para la Prevención del Cáncer, San
Salvador, El Salvador; Jacqueline Figueroa, Unidad de Registro de
Cáncer, Secretaria de Salud, Tegucigalpa; Ricardo Dominguez,
Hospital de Occidente, Secretaria de Salud, Copán, Honduras; Ofelia
Rojas, Rosario Pereira, and Carla Rivera,
Universidad Nacional Autónoma de Nicaragua, León, Nicaragua; and
Douglas R. Morgan, Vanderbilt University, Nashville, TN
| | - Eduardo Gharzouzi
- Marion Piñeros and Mathieu Laversanne,
International Agency for Research on Cancer, Lyon, France; Silvina
Frech, US National Cancer Institute, Bethesda, MD; Lindsay
Frazier, Dana-Farber/Children’s Cancer Center, Boston MA;
Joaquin Barnoya and Eduardo Gharzouzi, Instituto
de Cancerologia; Claudia Garrido, Unidad Nacional Oncología
Pediátrica, Guatemala City, Guatemala; Joaquin Barnoya,
Washington University in St. Louis, St. Louis, MO; Andrea
Chacón, Unidad Nacional para la Prevención y control del
Cáncer, Ministerio de Salud; Soad Fuentes Alabi, Hospital
Benjamín Bloom, Ministerio de Salud; Lisseth Ruiz de Campos,
Asociación Salvadoreña para la Prevención del Cáncer, San
Salvador, El Salvador; Jacqueline Figueroa, Unidad de Registro de
Cáncer, Secretaria de Salud, Tegucigalpa; Ricardo Dominguez,
Hospital de Occidente, Secretaria de Salud, Copán, Honduras; Ofelia
Rojas, Rosario Pereira, and Carla Rivera,
Universidad Nacional Autónoma de Nicaragua, León, Nicaragua; and
Douglas R. Morgan, Vanderbilt University, Nashville, TN
| | - Andrea Chacón
- Marion Piñeros and Mathieu Laversanne,
International Agency for Research on Cancer, Lyon, France; Silvina
Frech, US National Cancer Institute, Bethesda, MD; Lindsay
Frazier, Dana-Farber/Children’s Cancer Center, Boston MA;
Joaquin Barnoya and Eduardo Gharzouzi, Instituto
de Cancerologia; Claudia Garrido, Unidad Nacional Oncología
Pediátrica, Guatemala City, Guatemala; Joaquin Barnoya,
Washington University in St. Louis, St. Louis, MO; Andrea
Chacón, Unidad Nacional para la Prevención y control del
Cáncer, Ministerio de Salud; Soad Fuentes Alabi, Hospital
Benjamín Bloom, Ministerio de Salud; Lisseth Ruiz de Campos,
Asociación Salvadoreña para la Prevención del Cáncer, San
Salvador, El Salvador; Jacqueline Figueroa, Unidad de Registro de
Cáncer, Secretaria de Salud, Tegucigalpa; Ricardo Dominguez,
Hospital de Occidente, Secretaria de Salud, Copán, Honduras; Ofelia
Rojas, Rosario Pereira, and Carla Rivera,
Universidad Nacional Autónoma de Nicaragua, León, Nicaragua; and
Douglas R. Morgan, Vanderbilt University, Nashville, TN
| | - Soad Fuentes Alabi
- Marion Piñeros and Mathieu Laversanne,
International Agency for Research on Cancer, Lyon, France; Silvina
Frech, US National Cancer Institute, Bethesda, MD; Lindsay
Frazier, Dana-Farber/Children’s Cancer Center, Boston MA;
Joaquin Barnoya and Eduardo Gharzouzi, Instituto
de Cancerologia; Claudia Garrido, Unidad Nacional Oncología
Pediátrica, Guatemala City, Guatemala; Joaquin Barnoya,
Washington University in St. Louis, St. Louis, MO; Andrea
Chacón, Unidad Nacional para la Prevención y control del
Cáncer, Ministerio de Salud; Soad Fuentes Alabi, Hospital
Benjamín Bloom, Ministerio de Salud; Lisseth Ruiz de Campos,
Asociación Salvadoreña para la Prevención del Cáncer, San
Salvador, El Salvador; Jacqueline Figueroa, Unidad de Registro de
Cáncer, Secretaria de Salud, Tegucigalpa; Ricardo Dominguez,
Hospital de Occidente, Secretaria de Salud, Copán, Honduras; Ofelia
Rojas, Rosario Pereira, and Carla Rivera,
Universidad Nacional Autónoma de Nicaragua, León, Nicaragua; and
Douglas R. Morgan, Vanderbilt University, Nashville, TN
| | - Lisseth Ruiz de Campos
- Marion Piñeros and Mathieu Laversanne,
International Agency for Research on Cancer, Lyon, France; Silvina
Frech, US National Cancer Institute, Bethesda, MD; Lindsay
Frazier, Dana-Farber/Children’s Cancer Center, Boston MA;
Joaquin Barnoya and Eduardo Gharzouzi, Instituto
de Cancerologia; Claudia Garrido, Unidad Nacional Oncología
Pediátrica, Guatemala City, Guatemala; Joaquin Barnoya,
Washington University in St. Louis, St. Louis, MO; Andrea
Chacón, Unidad Nacional para la Prevención y control del
Cáncer, Ministerio de Salud; Soad Fuentes Alabi, Hospital
Benjamín Bloom, Ministerio de Salud; Lisseth Ruiz de Campos,
Asociación Salvadoreña para la Prevención del Cáncer, San
Salvador, El Salvador; Jacqueline Figueroa, Unidad de Registro de
Cáncer, Secretaria de Salud, Tegucigalpa; Ricardo Dominguez,
Hospital de Occidente, Secretaria de Salud, Copán, Honduras; Ofelia
Rojas, Rosario Pereira, and Carla Rivera,
Universidad Nacional Autónoma de Nicaragua, León, Nicaragua; and
Douglas R. Morgan, Vanderbilt University, Nashville, TN
| | - Jacqueline Figueroa
- Marion Piñeros and Mathieu Laversanne,
International Agency for Research on Cancer, Lyon, France; Silvina
Frech, US National Cancer Institute, Bethesda, MD; Lindsay
Frazier, Dana-Farber/Children’s Cancer Center, Boston MA;
Joaquin Barnoya and Eduardo Gharzouzi, Instituto
de Cancerologia; Claudia Garrido, Unidad Nacional Oncología
Pediátrica, Guatemala City, Guatemala; Joaquin Barnoya,
Washington University in St. Louis, St. Louis, MO; Andrea
Chacón, Unidad Nacional para la Prevención y control del
Cáncer, Ministerio de Salud; Soad Fuentes Alabi, Hospital
Benjamín Bloom, Ministerio de Salud; Lisseth Ruiz de Campos,
Asociación Salvadoreña para la Prevención del Cáncer, San
Salvador, El Salvador; Jacqueline Figueroa, Unidad de Registro de
Cáncer, Secretaria de Salud, Tegucigalpa; Ricardo Dominguez,
Hospital de Occidente, Secretaria de Salud, Copán, Honduras; Ofelia
Rojas, Rosario Pereira, and Carla Rivera,
Universidad Nacional Autónoma de Nicaragua, León, Nicaragua; and
Douglas R. Morgan, Vanderbilt University, Nashville, TN
| | - Ricardo Dominguez
- Marion Piñeros and Mathieu Laversanne,
International Agency for Research on Cancer, Lyon, France; Silvina
Frech, US National Cancer Institute, Bethesda, MD; Lindsay
Frazier, Dana-Farber/Children’s Cancer Center, Boston MA;
Joaquin Barnoya and Eduardo Gharzouzi, Instituto
de Cancerologia; Claudia Garrido, Unidad Nacional Oncología
Pediátrica, Guatemala City, Guatemala; Joaquin Barnoya,
Washington University in St. Louis, St. Louis, MO; Andrea
Chacón, Unidad Nacional para la Prevención y control del
Cáncer, Ministerio de Salud; Soad Fuentes Alabi, Hospital
Benjamín Bloom, Ministerio de Salud; Lisseth Ruiz de Campos,
Asociación Salvadoreña para la Prevención del Cáncer, San
Salvador, El Salvador; Jacqueline Figueroa, Unidad de Registro de
Cáncer, Secretaria de Salud, Tegucigalpa; Ricardo Dominguez,
Hospital de Occidente, Secretaria de Salud, Copán, Honduras; Ofelia
Rojas, Rosario Pereira, and Carla Rivera,
Universidad Nacional Autónoma de Nicaragua, León, Nicaragua; and
Douglas R. Morgan, Vanderbilt University, Nashville, TN
| | - Ofelia Rojas
- Marion Piñeros and Mathieu Laversanne,
International Agency for Research on Cancer, Lyon, France; Silvina
Frech, US National Cancer Institute, Bethesda, MD; Lindsay
Frazier, Dana-Farber/Children’s Cancer Center, Boston MA;
Joaquin Barnoya and Eduardo Gharzouzi, Instituto
de Cancerologia; Claudia Garrido, Unidad Nacional Oncología
Pediátrica, Guatemala City, Guatemala; Joaquin Barnoya,
Washington University in St. Louis, St. Louis, MO; Andrea
Chacón, Unidad Nacional para la Prevención y control del
Cáncer, Ministerio de Salud; Soad Fuentes Alabi, Hospital
Benjamín Bloom, Ministerio de Salud; Lisseth Ruiz de Campos,
Asociación Salvadoreña para la Prevención del Cáncer, San
Salvador, El Salvador; Jacqueline Figueroa, Unidad de Registro de
Cáncer, Secretaria de Salud, Tegucigalpa; Ricardo Dominguez,
Hospital de Occidente, Secretaria de Salud, Copán, Honduras; Ofelia
Rojas, Rosario Pereira, and Carla Rivera,
Universidad Nacional Autónoma de Nicaragua, León, Nicaragua; and
Douglas R. Morgan, Vanderbilt University, Nashville, TN
| | - Rosario Pereira
- Marion Piñeros and Mathieu Laversanne,
International Agency for Research on Cancer, Lyon, France; Silvina
Frech, US National Cancer Institute, Bethesda, MD; Lindsay
Frazier, Dana-Farber/Children’s Cancer Center, Boston MA;
Joaquin Barnoya and Eduardo Gharzouzi, Instituto
de Cancerologia; Claudia Garrido, Unidad Nacional Oncología
Pediátrica, Guatemala City, Guatemala; Joaquin Barnoya,
Washington University in St. Louis, St. Louis, MO; Andrea
Chacón, Unidad Nacional para la Prevención y control del
Cáncer, Ministerio de Salud; Soad Fuentes Alabi, Hospital
Benjamín Bloom, Ministerio de Salud; Lisseth Ruiz de Campos,
Asociación Salvadoreña para la Prevención del Cáncer, San
Salvador, El Salvador; Jacqueline Figueroa, Unidad de Registro de
Cáncer, Secretaria de Salud, Tegucigalpa; Ricardo Dominguez,
Hospital de Occidente, Secretaria de Salud, Copán, Honduras; Ofelia
Rojas, Rosario Pereira, and Carla Rivera,
Universidad Nacional Autónoma de Nicaragua, León, Nicaragua; and
Douglas R. Morgan, Vanderbilt University, Nashville, TN
| | - Carla Rivera
- Marion Piñeros and Mathieu Laversanne,
International Agency for Research on Cancer, Lyon, France; Silvina
Frech, US National Cancer Institute, Bethesda, MD; Lindsay
Frazier, Dana-Farber/Children’s Cancer Center, Boston MA;
Joaquin Barnoya and Eduardo Gharzouzi, Instituto
de Cancerologia; Claudia Garrido, Unidad Nacional Oncología
Pediátrica, Guatemala City, Guatemala; Joaquin Barnoya,
Washington University in St. Louis, St. Louis, MO; Andrea
Chacón, Unidad Nacional para la Prevención y control del
Cáncer, Ministerio de Salud; Soad Fuentes Alabi, Hospital
Benjamín Bloom, Ministerio de Salud; Lisseth Ruiz de Campos,
Asociación Salvadoreña para la Prevención del Cáncer, San
Salvador, El Salvador; Jacqueline Figueroa, Unidad de Registro de
Cáncer, Secretaria de Salud, Tegucigalpa; Ricardo Dominguez,
Hospital de Occidente, Secretaria de Salud, Copán, Honduras; Ofelia
Rojas, Rosario Pereira, and Carla Rivera,
Universidad Nacional Autónoma de Nicaragua, León, Nicaragua; and
Douglas R. Morgan, Vanderbilt University, Nashville, TN
| | - Douglas R. Morgan
- Marion Piñeros and Mathieu Laversanne,
International Agency for Research on Cancer, Lyon, France; Silvina
Frech, US National Cancer Institute, Bethesda, MD; Lindsay
Frazier, Dana-Farber/Children’s Cancer Center, Boston MA;
Joaquin Barnoya and Eduardo Gharzouzi, Instituto
de Cancerologia; Claudia Garrido, Unidad Nacional Oncología
Pediátrica, Guatemala City, Guatemala; Joaquin Barnoya,
Washington University in St. Louis, St. Louis, MO; Andrea
Chacón, Unidad Nacional para la Prevención y control del
Cáncer, Ministerio de Salud; Soad Fuentes Alabi, Hospital
Benjamín Bloom, Ministerio de Salud; Lisseth Ruiz de Campos,
Asociación Salvadoreña para la Prevención del Cáncer, San
Salvador, El Salvador; Jacqueline Figueroa, Unidad de Registro de
Cáncer, Secretaria de Salud, Tegucigalpa; Ricardo Dominguez,
Hospital de Occidente, Secretaria de Salud, Copán, Honduras; Ofelia
Rojas, Rosario Pereira, and Carla Rivera,
Universidad Nacional Autónoma de Nicaragua, León, Nicaragua; and
Douglas R. Morgan, Vanderbilt University, Nashville, TN
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9
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Aristizabal P, Fuller S, Rivera-Gomez R, Ornelas M, Nuno L, Rodriguez-Galindo C, Ribeiro R, Roberts W. Addressing regional disparities in pediatric oncology: Results of a collaborative initiative across the Mexican-North American border. Pediatr Blood Cancer 2017; 64:10.1002/pbc.26387. [PMID: 28000395 PMCID: PMC5608088 DOI: 10.1002/pbc.26387] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/27/2016] [Accepted: 10/26/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Cancer is emerging as a major cause of childhood mortality in low- and middle-income countries. In Mexico, cancer is the number one cause of death in children aged 5-14. Until recently, many children with cancer from Baja California, Mexico, went untreated. We reasoned that an initiative inspired by the St. Jude Children's Research Hospital (SJCRH) "twinning" model could successfully be applied to the San Diego-Tijuana border region. In 2008, a twinning project was initiated by Rady Children's Hospital, SJCRH, and the General Hospital Tijuana (GHT). Our aim was to establish a pediatric oncology unit in a culturally sensitive manner, adapted to the local healthcare system. PROCEDURE An initial assessment revealed that despite existence of basic hospital infrastructure at the GHT, the essential elements of a pediatric cancer unit were lacking, including dedicated space, trained staff, and uniform treatment. A 5-year action plan was designed to offer training, support the staff financially, and improve the infrastructure. RESULTS After 7 years, accomplishments include the opening of a new inpatient unit with updated technology, fully trained staff, and a dedicated, interdisciplinary team. Over 700 children have benefited from accurate diagnosis and treatment. CONCLUSIONS Initiatives that implement long-term partnerships between institutions along the Mexican-North American border can be highly effective in establishing successful pediatric cancer control programs. The geographic proximity facilitated accelerated training and close monitoring of project development. Similar initiatives across other disciplines may benefit additional patients and synergize with pediatric oncology programs to reduce health disparities in underserved areas.
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Affiliation(s)
- Paula Aristizabal
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of California San Diego, La Jolla, CA, USA,Peckham Center for Cancer and Blood Disorders, Rady Children's Hospital San Diego, San Diego, CA, USA,Reducing Cancer Disparities Program, Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Spencer Fuller
- School of Medicine, University of California San Diego, La Jolla, CA, USA; Johns Hopkins Bloomberg School of Public Health
| | - Rebeca Rivera-Gomez
- Hospital General de Tijuana, Universidad Autonoma de Baja California, Tijuana, Baja California, Mexico
| | - Mario Ornelas
- Hospital General de Tijuana, Universidad Autonoma de Baja California, Tijuana, Baja California, Mexico
| | - Laura Nuno
- Hospital General de Tijuana, Universidad Autonoma de Baja California, Tijuana, Baja California, Mexico
| | - Carlos Rodriguez-Galindo
- Department of Global Pediatric Medicine and International Outreach Program, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Raul Ribeiro
- Department of Oncology, Leukemia and Lymphoma Division, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - William Roberts
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of California San Diego, La Jolla, CA, USA,Peckham Center for Cancer and Blood Disorders, Rady Children's Hospital San Diego, San Diego, CA, USA,Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
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10
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Montini G, Edefonti A, Galán YS, Sandoval Díaz M, Medina Manzanarez M, Marra G, Robusto F, Tognoni G, Sereni F. Non-Medical Risk Factors as Avoidable Determinants of Excess Mortality in Children with Chronic Kidney Disease. A Prospective Cohort Study in Nicaragua, a Model Low Income Country. PLoS One 2016; 11:e0153963. [PMID: 27171479 PMCID: PMC4865233 DOI: 10.1371/journal.pone.0153963] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 04/06/2016] [Indexed: 11/19/2022] Open
Abstract
Background The widely recognized clinical and epidemiological relevance of the socioeconomic determinants of health-disease conditions is expected to be specifically critical in terms of chronic diseases in fragile populations in low-income countries. However, in the literature, there is a substantial gap between the attention directed towards the medical components of these problems and the actual adoption of strategies aimed at providing solutions for the associated socioeconomic determinants, especially in pediatric populations. We report a prospective outcome study on the independent contribution and reciprocal interaction of the medical and socioeconomic factors to the hard end-point of mortality in a cohort of children with chronic kidney disease in Nicaragua. Methods and Findings Every child (n = 309) diagnosed with chronic kidney disease (CKD) and referred to the tertiary unit of Pediatric Nephrology in Managua (Nicaragua) from a network of nine hospitals serving 80% of the country’s pediatric population was registered between January 2005 and December 2013. The three main socioeconomic determinants evaluated were family income, living conditions and the family’s level of education. Further potential determinants of the outcomes included duration of exposure to disease, CKD stage at the first visit as suggested by the KDOQI guidelines in children, the time it took the patients to reach the reference centre and rural or urban context of life. Well-defined and systematically collected medical and socioeconomic data were available for 257 children over a mean follow-up period of 2.5±2.5 years. Mortality and lost to follow-up were considered as outcome end-points both independently and in combination, because of the inevitably progressive nature of the disease. A high proportion (55%) of children presented in the advanced stages of CKD (CKD stage IV and V) at the first visit. At the end of follow-up, 145 (57%) of the 257 cohort children were alive, 47 (18%) were lost to follow-up and 65 (25%) had died. Cox regression analysis showed an independent contribution to mortality of CKD stage at diagnosis and of level of education, with overlapping HR values (HR and 95%CI: 2.66; 1.93–3.66 and 2.72; 1.71–4.33, respectively). Conclusions The unfavourable socioeconomic and cultural background of the pediatric study cohort and the severity of kidney damage at diagnosis were the key determinants of the clinical risk conditions at baseline and of the mortality outcome. Long-term structural interventions on such backgrounds must be adopted to assure effectiveness of medical care and to assure an earlier diagnosis of CKD in these patients. The translation-extension of our results is currently underway with an agenda which includes: 1) better integration of chronic pediatric conditions into primary care strategies to promote prevention and early timely referral; 2) the consideration of socioeconomic conditions as a mandatory component of the packages of best-care; 3) the formulation and flexible adaptation of guidelines and educational programs, based on the information generated by a context-specific, epidemiological monitoring of needs and outcomes, guaranteed by an effective database.
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Affiliation(s)
- Giovanni Montini
- Pediatric Nephrology and Dialysis Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- * E-mail:
| | - Alberto Edefonti
- Pediatric Nephrology and Dialysis Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Yajaira Silva Galán
- Pediatric Nephrology and Dialysis Unit, Hospital Infantil Manuel de Jesus Rivera “La Mascota”, Managua, Nicaragua
| | - Mabel Sandoval Díaz
- Pediatric Nephrology and Dialysis Unit, Hospital Infantil Manuel de Jesus Rivera “La Mascota”, Managua, Nicaragua
| | - Marta Medina Manzanarez
- Pediatric Nephrology and Dialysis Unit, Hospital Infantil Manuel de Jesus Rivera “La Mascota”, Managua, Nicaragua
| | - Giuseppina Marra
- Pediatric Nephrology and Dialysis Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Fabio Robusto
- Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy
| | | | - Fabio Sereni
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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11
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12
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Ribeiro RC, Antillon F, Pedrosa F, Pui CH. Global Pediatric Oncology: Lessons From Partnerships Between High-Income Countries and Low- to Mid-Income Countries. J Clin Oncol 2015; 34:53-61. [PMID: 26578620 DOI: 10.1200/jco.2015.61.9148] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Partnerships between medical institutions in high-income countries (HICs) and low- to mid-income countries (LMICs) have succeeded in initiating and expanding pediatric cancer control efforts. The long-term goal is consistently a sustainable national pediatric cancer program. Here, we review the elements required for successful implementation, development, and long-term sustainability of pediatric cancer programs in LMICs that first arise as partnerships with institutions in HICs. Although plans must be adapted to each country's resources, certain components are unfailingly necessary. First, an essential step is provision of treatment regardless of ability to pay. Second, financial support for program development and long-term sustainability must be sought from sources both international and local, public and private. A local leader, typically a well-trained pediatric oncologist who devotes full-time effort to the project, should direct medical care and collaborate with hospital, governmental, and community leadership and international agencies. Third, nurses must be trained in pediatric cancer care and allowed to practice this specialty full-time. It is also essential to develop a grassroots organization, such as a foundation, dedicated solely to pediatric oncology. Its members must be trained and educated to provide pediatric cancer advocacy, fundraising, and (in concert with government) program sustainability. Finally, a project mentor in the HIC is crucial and should explore the possibility of collaborative research in the LMIC, which may offer significant opportunities. Relationships between the partnership's leaders and influential individuals in the community, hospital, grassroots foundation, and government will lay the foundation for productive collaboration and a sustainable pediatric oncology program.
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Affiliation(s)
- Raul C Ribeiro
- Raul C. Ribeiro and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Federico Antillon, Unidad Nacional de Oncologia Pediatrica and Universidad Francisco Marroquin, Guatemala City, Guatemala; and Francisco Pedrosa, Instituto de Medicina Integral Fernando Figueira, Recife, Brazil.
| | - Federico Antillon
- Raul C. Ribeiro and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Federico Antillon, Unidad Nacional de Oncologia Pediatrica and Universidad Francisco Marroquin, Guatemala City, Guatemala; and Francisco Pedrosa, Instituto de Medicina Integral Fernando Figueira, Recife, Brazil
| | - Francisco Pedrosa
- Raul C. Ribeiro and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Federico Antillon, Unidad Nacional de Oncologia Pediatrica and Universidad Francisco Marroquin, Guatemala City, Guatemala; and Francisco Pedrosa, Instituto de Medicina Integral Fernando Figueira, Recife, Brazil
| | - Ching-Hon Pui
- Raul C. Ribeiro and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Federico Antillon, Unidad Nacional de Oncologia Pediatrica and Universidad Francisco Marroquin, Guatemala City, Guatemala; and Francisco Pedrosa, Instituto de Medicina Integral Fernando Figueira, Recife, Brazil
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13
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Layton Tovar CF, Mendieta Zerón H. Intracellular Signaling Pathways Involved in Childhood Acute Lymphoblastic Leukemia; Molecular Targets. Indian J Hematol Blood Transfus 2015; 32:141-53. [PMID: 27065575 DOI: 10.1007/s12288-015-0609-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 10/09/2015] [Indexed: 01/17/2023] Open
Abstract
Acute lymphoblastic leukemia (ALL) is a malignant disease characterized by an uncontrolled proliferation of immature lymphoid cells. ALL is the most common hematologic malignancy in early childhood, and it reaches peak incidence between the ages of 2 and 3 years. The prognosis of ALL is associated with aberrant gene expression, in addition to the presence of numerical or structural chromosomal alterations, age, race, and immunophenotype. The Relapse rate with regard to pharmacological treatment rises in childhood; thus, the expression of biomarkers associated with the activation of cell signaling pathways is crucial to establish the disease prognosis. Intracellular pathways involved in ALL are diverse, including Janus kinase/Signal transducers and transcription activators (JAK-STAT), Phosphoinositide-3-kinase-protein kinase B (PI3K-AKT), Ras mitogen-activated protein kinase (Ras-MAPK), Glycogen synthase kinase-3β (GSK-3β), Nuclear factor-kappa beta (NF-κB), and Hypoxia-inducible transcription factor 1α (HIF-1α), among others. In this review, we present several therapeutic targets, intracellular pathways, and molecular markers that are being studied extensively at present.
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Affiliation(s)
- Cristian Fabián Layton Tovar
- Facultad de Medicina, Universidad Autónoma del Estado de México (UAEMex), Paseo Tollocan esq. Jesús Carranza, Col. Moderna de la Cruz, 50180 Toluca, Estado de Mexico Mexico
| | - Hugo Mendieta Zerón
- Facultad de Medicina, Universidad Autónoma del Estado de México (UAEMex), Paseo Tollocan esq. Jesús Carranza, Col. Moderna de la Cruz, 50180 Toluca, Estado de Mexico Mexico ; Asociación Científica Latina A.C. (ASCILA) and Ciprés Grupo Médico (CGM), Felipe Villanueva sur 1209, Col. Rancho Dolores, 50170 Toluca, Estado de Mexico Mexico
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Viana SS, de Lima LMMR, do Nascimento JB, Cardoso CAF, Rosário ACD, Mendonça CDQ, de Menezes-Neto OA, Cipolotti R. Secular trends and predictors of mortality in acute lymphoblastic leukemia for children of low socioeconomic level in Northeast Brazil. Leuk Res 2015; 39:1060-5. [DOI: 10.1016/j.leukres.2015.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 07/09/2015] [Accepted: 07/16/2015] [Indexed: 11/30/2022]
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15
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Suarez A, Piña M, Nichols-Vinueza DX, Lopera J, Rengifo L, Mesa M, Cardenas M, Morrissey L, Veintemilla G, Vizcaino M, Del Toro L, Vicuna V, Fernandez J, Neuberg D, Stevenson K, Gutierrez A. A strategy to improve treatment-related mortality and abandonment of therapy for childhood ALL in a developing country reveals the impact of treatment delays. Pediatr Blood Cancer 2015; 62:1395-402. [PMID: 25808195 DOI: 10.1002/pbc.25510] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 02/19/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND Treatment-related mortality and abandonment of therapy are major barriers to successful treatment of childhood acute lymphoblastic leukemia (ALL) in the developing world. PROCEDURE A collaboration was undertaken between Instituto Nacional de Cancerologia (Bogota, Colombia), which serves a poor patient population in an upper-middle income country, and Dana-Farber/Boston Children's Cancer and Blood Disorders Center (Boston, USA). Several interventions aimed at reducing toxic deaths and abandonment were implemented, including a reduced-intensity treatment regimen and a psychosocial effort targeting abandonment. We performed a cohort study to assess impact. RESULTS The Study Population comprised 99 children with ALL diagnosed between 2007 and 2010, and the Historic Cohort comprised 181 children treated prior to the study interventions (1995-2004). Significant improvements were achieved in the rate of deaths in complete remission (13% to 3%; P = 0.005), abandonment (32% to 9%; P < 0.001), and event-free survival with abandonment considered an event (47% to 65% at 2 years; P = 0.016). However, relapse rate did not improve. Medically unnecessary treatment delays were common, and landmark analysis revealed that initiating the PIII phase of therapy ≥4 weeks delayed predicted markedly inferior disease-free survival (P = 0.016). Conversely, patients who received therapy without excessive delays had outcomes approaching those achieved in high-income countries. CONCLUSIONS Implementation of a twinning program was followed by reductions in abandonment and toxic deaths, but relapse rate did not improve. Inappropriate treatment delays were common and strongly predicted treatment failure. These findings highlight the importance of adherence to treatment schedule for effective therapy of ALL.
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Affiliation(s)
- Amaranto Suarez
- Department of Pediatrics, Instituto Nacional de Cancerologia, Bogota, Colombia
| | - Martha Piña
- Department of Pediatrics, Instituto Nacional de Cancerologia, Bogota, Colombia
| | - Diana X Nichols-Vinueza
- Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - John Lopera
- Department of Pediatrics, Instituto Nacional de Cancerologia, Bogota, Colombia
| | - Lyda Rengifo
- Department of Pediatrics, Instituto Nacional de Cancerologia, Bogota, Colombia
| | - Mauricio Mesa
- Department of Pediatrics, Instituto Nacional de Cancerologia, Bogota, Colombia
| | - Marcela Cardenas
- Department of Pediatrics, Instituto Nacional de Cancerologia, Bogota, Colombia
| | - Lisa Morrissey
- Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Galo Veintemilla
- Department of Surgery, Instituto Nacional de Cancerologia, Bogota, Colombia
| | - Martha Vizcaino
- Department of Pediatrics, Instituto Nacional de Cancerologia, Bogota, Colombia
| | - Ligia Del Toro
- Department of Pediatrics, Instituto Nacional de Cancerologia, Bogota, Colombia
| | - Victor Vicuna
- Department of Pediatrics, Instituto Nacional de Cancerologia, Bogota, Colombia
| | - Jorge Fernandez
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Donna Neuberg
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Kristen Stevenson
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Alejandro Gutierrez
- Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
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16
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Caniza MA, Odio C, Mukkada S, Gonzalez M, Ceppi F, Chaisavaneeyakorn S, Apiwattanakul N, Howard SC, Conter V, Bonilla M. Infectious complications in children with acute lymphoblastic leukemia treated in low-middle-income countries. Expert Rev Hematol 2015. [PMID: 26211675 DOI: 10.1586/17474086.2015.1071186] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Infections are the most important cause of morbidity and mortality in children treated for acute lymphoblastic leukemia (ALL). The rates of infection-associated mortality are up to 10-times higher in low- and middle-income countries (LMIC) than in high-income countries. The prevention, early recognition and management of infectious complications is especially challenging in LMIC because of disease and poverty-related factors, as well as the shortage of trained personnel, supplies, diagnostic tools and adequate organizational infrastructure. Children in LMIC with ALL, who are frequently underweight, are at increased risk of community-acquired pathogens, nosocomial multidrug-resistant pathogens and opportunistic microorganisms. This review summarizes the challenges of managing the major categories of infections in children receiving treatment for ALL and provides updated practical recommendations for preventing and managing these infections in LMIC.
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Affiliation(s)
- Miguela A Caniza
- a 1 Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN, USA
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17
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Ceppi F, Antillon F, Pacheco C, Sullivan CE, Lam CG, Howard SC, Conter V. Supportive medical care for children with acute lymphoblastic leukemia in low- and middle-income countries. Expert Rev Hematol 2015; 8:613-26. [DOI: 10.1586/17474086.2015.1049594] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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18
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Gajjar A, Finlay JL. The management of children and adolescents with medulloblastoma in low and middle income countries. Pediatr Blood Cancer 2015; 62:549-50. [PMID: 25545387 DOI: 10.1002/pbc.25371] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 10/29/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Amar Gajjar
- Department of Oncology, Division of Neuro-oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
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Survival of Mexican Children with Acute Lymphoblastic Leukaemia under Treatment with the Protocol from the Dana-Farber Cancer Institute 00-01. BIOMED RESEARCH INTERNATIONAL 2015; 2015:576950. [PMID: 25922837 PMCID: PMC4398910 DOI: 10.1155/2015/576950] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 10/03/2014] [Accepted: 10/17/2014] [Indexed: 11/18/2022]
Abstract
Our aim in this paper is to describe the results of treatment of acute lymphoblastic leukaemia (ALL) in Mexican children treated from 2006 to 2010 under the protocol from the Dana-Farber Cancer Institute (DFCI) 00-01. The children were younger than 16 years of age and had a diagnosis of ALL de novo. The patients were classified as standard risk if they were 1–9.9 years old and had a leucocyte count <50 × 109/L, precursor B cell immunophenotype, no mediastinal mass, CSF free of blasts, and a good response to prednisone. The rest of the patients were defined as high risk. Of a total of 302 children, 51.7% were at high risk. The global survival rate was 63.9%, and the event-free survival rate was 52.3% after an average follow-up of 3.9 years. The percentages of patients who died were 7% on induction and 14.2% in complete remission; death was associated mainly with infection (21.5%). The relapse rate was 26.2%. The main factor associated with the occurrence of an event was a leucocyte count >100 × 109/L. The poor outcomes were associated with toxic death during induction, complete remission, and relapse. These factors remain the main obstacles to the success of this treatment in our population.
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