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Friedrich P, Mercado N, Echeandia-Abud N, Guerrero-Gomez K, González-Zamorano M, López-Ruíz MI, Portillo-Zavala CS, García-Segura LD, Reynoso-Gutiérrez M, López-Facundo NA, Cárdenas-Pedraza D, Valois-Escamilla MG, Mera-González AB, Covarrubias-Zapata D, Vollbrechtshausen-Castelán LA, Loeza-Oliva JDJ, Garay-Sánchez SA, Moreno-Serrano J, Mendoza-Sánchez P, Casillas-Toral P, Sandoval-Cabrera A, Gutiérrez-Martínez I, Jiménez-Osorio MI, Arce-Cabrera D, Aguilar-Escobar DV, González-Montalvo PM, Romo-Rubio HA. Securing access to a comprehensive diagnostic panel for children with suspected acute lymphoblastic leukemia: Results from the Mexico in Alliance with St. Jude "Bridge Project". Front Oncol 2024; 13:1286278. [PMID: 38288107 PMCID: PMC10824571 DOI: 10.3389/fonc.2023.1286278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/07/2023] [Indexed: 01/31/2024] Open
Abstract
Background The "Bridge Project" is a Mexico in Alliance with St. Jude (MAS) initiative developed in 2019 to improve access, accuracy, and timeliness of specialized diagnostic studies for patients with suspected acute lymphoblastic leukemia (ALL). The project strategy relies on service centralization to improve service delivery, biological characterization, risk-group classification, and support proper treatment allocation. Methods This is an ongoing prospective multisite intersectoral quality improvement (QI) project available to all patients 0-18 years of age presenting with suspected ALL to the 14 actively participating institutions in 12 Mexican states. Institutions send specimens to one centralized laboratory. From a clinical standpoint, the project secures access to a consensus-derived comprehensive diagnostic panel. From a service delivery standpoint, we assess equity, timeliness, effectiveness, and patient-centeredness. From an implementation science standpoint, we document feasibility, utility, and appropriateness of the diagnostic panel and centralized approach. This analysis spans from July 2019 to June 2023. Results 612 patients have accessed the project. The median age was 6 years (IQR 3-11), and 53% were males. 94% of the specimens arrived within 48 hours, which documents the feasibility of the centralized model, and 100% of the patients received precise and timely diagnostic results, which documents the effectiveness of the approach. Of 505 (82.5%) patients with confirmed ALL, 463/505 (91.6%) had B-cell ALL, and 42/505 (8.3%) had T-cell ALL. High-hyperdiploidy was detected by DNA index in 36.6% and hypodiploidy in 1.6%. 76.6% of the patients had conclusive karyotype results. FISH studies showed t(12;21) in 15%, iAMP21 in 8.5%, t(1;19) in 7.5%, t(4;11) in 4.2%, t(9;22) in 3.2%, del(9)(p21) in 1.8%, and TRA/D (14)(q11.2) rearrangement in 2.4%. Among B-cell ALL patients, 344/403 (85.1%) had Day 15 MRD<1% and 261/305 (85.6%) Day 84 MRD<0.01. For T-cell ALL patients 20/28 (71.4%) had Day 29 MRD<0.01% and 19/22 (86.4%) Day 84 MRD<0.01%. Conclusions By securing access to a standardized consensus-derived diagnostic panel, the Bridge Project has allowed better characterization of childhood ALL in Mexico while producing unprecedented service improvements and documenting key implementation outcomes. We are using these results to inform iterative changes to the diagnostic panel and an associated treatment guideline (MAS-ALL18).
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Affiliation(s)
- Paola Friedrich
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Nataly Mercado
- Casa de la Amistad para Niños con Cáncer, Institución de Asistencia Privada, I.A.P., Ciudad de México, Mexico
| | - Naomi Echeandia-Abud
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Karla Guerrero-Gomez
- Casa de la Amistad para Niños con Cáncer, Institución de Asistencia Privada, I.A.P., Ciudad de México, Mexico
| | - Margarita González-Zamorano
- Pediatric Oncology and Hematology Department, Hospital General con Especialidades “Juan María de Salvatierra”, La Paz, Mexico
| | - Mayra Ivette López-Ruíz
- Pediatric Oncology Department, Hospital de Especialidades Pediátricas, Tuxtla Gutiérrez, Mexico
| | | | | | | | - Norma Araceli López-Facundo
- Pediatric Oncology Department, Hospital Materno Infantil del Instituto de Seguridad Social del Estado de México y Municipios, Toluca, Mexico
| | - Daniela Cárdenas-Pedraza
- Pediatric Oncology and Hematology Department, Hospital para el Niño del Instituto Materno Infantil del Estado de México, Toluca de Lerdo, Mexico
| | | | - Alma Beatriz Mera-González
- Hematology Department, Hospital del Niño Desarrollo Integral de la Familia (DIF) Hidalgo, Pachuca de Soto, Mexico
| | - Daniela Covarrubias-Zapata
- Pediatric Oncology Department, Centro Estatal de Oncología “Dr. Luis González Francis”, Campeche, Mexico
| | | | - José de Jesús Loeza-Oliva
- Pediatric Oncology Department, Centro Estatal de Cancerología “Dr. Miguel Dorantes Mesa”, Xalapa, Mexico
| | | | - Julio Moreno-Serrano
- Diagnostic and Bood Bank Department, Hospital Infantil Teletón de Oncología, Querétaro, Mexico
| | | | - Paola Casillas-Toral
- Pediatric Oncology and Hematology Department, Hospital Civil de Guadalajara “Dr. Juan I. Menchaca”, Guadalajara, Mexico
| | - Antonio Sandoval-Cabrera
- Pediatric Oncology and Hematology Department, Hospital para el Niño del Instituto Materno Infantil del Estado de México, Toluca de Lerdo, Mexico
| | - Itzel Gutiérrez-Martínez
- Pediatric Oncology Department, Hospital Infantil de Morelia "Eva Sámano de López Mateos", Morelia, Mexico
| | | | - Daniela Arce-Cabrera
- Pediatric Oncology and Hematology Department, Hospital Pediátrico de Sinaloa, Culiacán, Mexico
| | | | | | - Hugo Antonio Romo-Rubio
- Pediatric Oncology and Hematology Department, Hospital Civil de Guadalajara “Dr. Juan I. Menchaca”, Guadalajara, Mexico
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