BACKGROUND: Five Asociación de Hemato-Oncología de Centroamérica (AHOPCA) countries have used an adapted BFM-based protocol for childhood acute lymphoblastic leukemia (ALL). PROCEDURE: In the AHOPCA-ALL 2008 protocol, patients were stratified by age, white blood cell count, immunophenotype, central nervous system involvement, day 8 prednisone response, and morphologic bone marrow response to induction therapy. Patients at Standard Risk (SR) received a three-drug induction regimen, a reinduction phase, and maintenance with protracted intrathecal therapy. Those at Intermediate (IR) and High Risk (HR) received, in addition, daunorubicin during induction therapy, a consolidation phase and two or three reinduction phases respectively. RESULTS: From August 2008 through July 2012, 1,313 patients were enrolled: 353 in SR, 548 in IR, 412 in HR. During induction therapy, 3.0% of patients died, 2.7% abandoned treatment, 1.1% had resistant ALL, and 93.2% achieved morphological complete remission (CR). Deaths and abandonment in first CR occurred in 2.7% and in 7.0% of patients, respectively. The relapse rate at a median observation time of 2.1 years was 15.0%. At 3 years, the event-free survival (EFS) and overall survival (OS), with abandonment considered as an event, were 59.4% (SE 1.7) and 68.2% (SE 1.6). Three-year EFS was 68.5% (SE 3.0), 62.1% (SE 2.6), and 47.8% (SE 3.2) for SR, IR, and HR groups. Adolescents had a significantly higher relapse rate (P = 0.001). CONCLUSIONS: This experience shows that common international studies are feasible in lower-middle income countries. Toxic deaths, abandonment of treatment, and relapses remain major obstacles to the successful treatment. Alternative treatment strategies may be beneficial.
BACKGROUND: Five Asociación de Hemato-Oncología de Centroamérica (AHOPCA) countries have used an adapted BFM-based protocol for childhood acute lymphoblastic leukemia (ALL). PROCEDURE: In the AHOPCA-ALL 2008 protocol, patients were stratified by age, white blood cell count, immunophenotype, central nervous system involvement, day 8 prednisone response, and morphologic bone marrow response to induction therapy. Patients at Standard Risk (SR) received a three-drug induction regimen, a reinduction phase, and maintenance with protracted intrathecal therapy. Those at Intermediate (IR) and High Risk (HR) received, in addition, daunorubicin during induction therapy, a consolidation phase and two or three reinduction phases respectively. RESULTS: From August 2008 through July 2012, 1,313 patients were enrolled: 353 in SR, 548 in IR, 412 in HR. During induction therapy, 3.0% of patients died, 2.7% abandoned treatment, 1.1% had resistant ALL, and 93.2% achieved morphological complete remission (CR). Deaths and abandonment in first CR occurred in 2.7% and in 7.0% of patients, respectively. The relapse rate at a median observation time of 2.1 years was 15.0%. At 3 years, the event-free survival (EFS) and overall survival (OS), with abandonment considered as an event, were 59.4% (SE 1.7) and 68.2% (SE 1.6). Three-year EFS was 68.5% (SE 3.0), 62.1% (SE 2.6), and 47.8% (SE 3.2) for SR, IR, and HR groups. Adolescents had a significantly higher relapse rate (P = 0.001). CONCLUSIONS: This experience shows that common international studies are feasible in lower-middle income countries. Toxic deaths, abandonment of treatment, and relapses remain major obstacles to the successful treatment. Alternative treatment strategies may be beneficial.
Authors: Iman Sidhom; Khaled Shaaban; Sarah H Youssef; Nesreen Ali; Seham Gohar; Wafaa M Rashed; Mai Mehanna; Sherine Salem; Sonya Soliman; Dina Yassin; Emad Mansour; Elaine Coustan-Smith; Raul C Ribeiro; Gaston K Rivera Journal: Blood Date: 2021-01-07 Impact factor: 25.476
Authors: Elva Jiménez-Hernández; Ethel Zulie Jaimes-Reyes; José Arellano-Galindo; Xochiketzalli García-Jiménez; Héctor Manuel Tiznado-García; María Teresa Dueñas-González; Octavio Martínez Villegas; Berenice Sánchez-Jara; Vilma Carolina Bekker-Méndez; María Guadalupe Ortíz-Torres; Antonio Ortíz-Fernández; Teresa Marín-Palomares; Juan Manuel Mejía-Aranguré Journal: Biomed Res Int Date: 2015-03-26 Impact factor: 3.411
Authors: J Smith Torres-Roman; Bryan Valcarcel; Pedro Guerra-Canchari; Camila Alves Dos Santos; Isabelle Ribeiro Barbosa; Carlo La Vecchia; Katherine A McGlynn; Dyego Leandro Bezerra de Souza Journal: BMC Pediatr Date: 2020-11-07 Impact factor: 2.125
Authors: Julianne E Burns; Dominga Reyes Pérez; Yimei Li; Wendy Gómez García; F Jay Garcia; Johanna Penélope Gil Jiménez; Jacqueline Sánchez; María Castillo Bueno; Stephen P Hunger; Lisa Reaves; Johanny Contreras González; Susan E Coffin; Adriana Deverlis; Andrew P Steenhoff; Brian T Fisher Journal: PLoS One Date: 2020-12-15 Impact factor: 3.240