دورية أكاديمية
أعرض في EDS

Retrospective analysis of outcomes for pediatric acute lymphoblastic leukemia in South American centers.

التفاصيل البيبلوغرافية
العنوان: Retrospective analysis of outcomes for pediatric acute lymphoblastic leukemia in South American centers.
المؤلفون: Duffy C; St. Jude Children's Research Hospital, Department of Global Pediatric Medicine, Memphis, TN, United States., Graetz DE; St. Jude Children's Research Hospital, Department of Global Pediatric Medicine, Memphis, TN, United States., Lopez AMZ; Departamento de Oncología Pediátrica, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru., Carrillo AK; St. Jude Children's Research Hospital, Department of Global Pediatric Medicine, Memphis, TN, United States., Job G; St. Jude Children's Research Hospital, Department of Global Pediatric Medicine, Memphis, TN, United States., Chen Y; St. Jude Children's Research Hospital, Department of Global Pediatric Medicine, Memphis, TN, United States., Devidas M; St. Jude Children's Research Hospital, Department of Global Pediatric Medicine, Memphis, TN, United States., Leon SA; Departamento de Oncología Pediátrica, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru., Bonzi SA; Departamento de Hemato Oncología Pediátrica, Hospital de Clínicas, Facultad de Ciencias Médicas, Universidad Nacional de Asunción, Asunción, Paraguay., Flores PC; Hospital Santa Cruz Caja Petrolera Salud (CPS), Hemato-Oncología Pediátrica, Santa Cruz, Bolivia., Torres LE; Hospital SOLCA Núcleo Quito, Hemato-Oncología Pediátrica, Quito, Ecuador., Broncano EH; Departamento de Oncología Pediátrica, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru., Jaramillo SJ; La Sociedad de Lucha Contra el Cáncer (SOLCA) Núcleo de Loja, Oncohematóloga Pediatra, Loja, Ecuador., Zelada MO; Departamento de Hemato Oncología Pediátrica, Hospital de Clínicas, Facultad de Ciencias Médicas, Universidad Nacional de Asunción, Asunción, Paraguay., Novoa RR; Departamento de Oncología Pediátrica, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru., Samudio A; Departamento de Hemato Oncología Pediátrica, Hospital de Clínicas, Facultad de Ciencias Médicas, Universidad Nacional de Asunción, Asunción, Paraguay., Sánchez-Fernandez G; Hospital SOLCA Núcleo Quito, Hemato-Oncología Pediátrica, Quito, Ecuador., Villanueva E; Hospital SOLCA Núcleo Quito, Hemato-Oncología Pediátrica, Quito, Ecuador., Metzger ML; Médecins Sans Frontières, Geneva, Switzerland., Friedrich P; St. Jude Children's Research Hospital, Department of Global Pediatric Medicine, Memphis, TN, United States., Jeha S; St. Jude Children's Research Hospital, Department of Global Pediatric Medicine, Memphis, TN, United States.
المصدر: Frontiers in oncology [Front Oncol] 2023 Oct 30; Vol. 13, pp. 1254233. Date of Electronic Publication: 2023 Oct 30 (Print Publication: 2023).
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Frontiers Research Foundation] Country of Publication: Switzerland NLM ID: 101568867 Publication Model: eCollection Cited Medium: Print ISSN: 2234-943X (Print) Linking ISSN: 2234943X NLM ISO Abbreviation: Front Oncol Subsets: PubMed not MEDLINE
أسماء مطبوعة: Original Publication: [Lausanne : Frontiers Research Foundation]
مستخلص: Introduction: Acute lymphoblastic Leukemia (ALL) is the most common pediatric malignancy. While the survival rate for childhood ALL exceeds 90% in high-income countries, the estimated survival in low-and middle-income countries ranges from 22-79%, depending on the region and local resources.
Methods: This study retrospectively reviewed demographic, biological, and clinical parameters of children under 18 years of age with newly diagnosed ALL presenting between 2013-2017 across five pediatric centers in 4 countries in South America. Survival analyses were estimated using the Kaplan-Meier method.
Results: Across the five centers, 752 patients were analyzed (Bolivia [N=9], Ecuador [N=221], Paraguay [N=197], Peru [N=325]) and 92.1% (n=690) patients were diagnosed with B-cell and 7.5% (n= 56) with T-cell ALL. The median age was 5.5 years old (IQR 7.29). At diagnosis, 47.8% of patients were categorized as standard and 51.9% as high risk per their institutional regimen. Advanced diagnostics availability varied between modalities. MRD was evaluated in 69.1% of patients; molecular testing was available for ETV6-RUNX, BCR-ABL1, TCF3-PBX1, and KMT2A-rearranged ALL in 75-81% of patients; however, karyotyping and evaluation for iAMP21 were only performed in 42-61% of patients. Central nervous system (CNS) involvement was evaluated at diagnosis in 57.3% (n=429) patients; of these, 93.7% (n=402) were CNS 1, 1.6% (n=7) were CNS 2, 0.7% (n=11) were CNS3, 1.9% (n=8) had cranial nerve palsy, and 2.1% (n=9) results unavailable. Chemotherapy delays >2 weeks were reported in 56.0% (n=421) patients during treatment. Delays were attributed to infection in 63.2% (n=265), drug-related toxicities in 47.3% (n=198), and resource constraints, including lack of bed availability in 23.2% (n=97) of patients. The 3-year Abandonment-sensitive EFS and OS were 61.0±1.9% and 67.2±1.8%, respectively. The 3-year EFS and OS were 71.0±1.8% and 79.6±1.7%, respectively.
Discussion: This work reveals opportunities to improve survival, including addressing severe infections, treatment interruptions, and modifications due to drug shortages. In 2018, healthcare professionals across South America established the Pediatric Oncology Latin America (POLA) group in collaboration with St. Jude Children's Research Hospital. POLA collaborators developed an evidence-based, consensus-derived, adapted treatment guideline, informed by preliminary results of this evaluation, to serve as the new standard of care for pediatric ALL in participating institutions.
Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
(Copyright © 2023 Duffy, Graetz, Lopez, Carrillo, Job, Chen, Devidas, Leon, Bonzi, Flores, Torres, Broncano, Jaramillo, Zelada, Novoa, Samudio, Sánchez-Fernandez, Villanueva, Metzger, Friedrich and Jeha.)
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فهرسة مساهمة: Keywords: acute lymphoblastic leukemia; consensus-derived; low-and middle-income country; multinational; pediatric; survival
تواريخ الأحداث: Date Created: 20231129 Latest Revision: 20231201
رمز التحديث: 20231215
مُعرف محوري في PubMed: PMC10643117
DOI: 10.3389/fonc.2023.1254233
PMID: 38023200
قاعدة البيانات: MEDLINE
الوصف
تدمد:2234-943X
DOI:10.3389/fonc.2023.1254233