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.

Navarrete, M., Rossi, E., Brivio, E., Carrillo, J., Bonilla, M., Vasquez, R., et al. (2014). Treatment of childhood acute lymphoblastic leukemia in central America: A lower-middle income countries experience. PEDIATRIC BLOOD & CANCER, 61(5), 803-809 [10.1002/pbc.24911].

Treatment of childhood acute lymphoblastic leukemia in central America: A lower-middle income countries experience

ROSSI, EMANUELA;BRIVIO, ERICA;MASERA, GIUSEPPE;BIONDI, ANDREA;VALSECCHI, MARIA GRAZIA
2014

Abstract

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.
Articolo in rivista - Articolo scientifico
acute lymphoblastic leukemia; low-middle income countries; childhood
English
803
809
7
Navarrete, M., Rossi, E., Brivio, E., Carrillo, J., Bonilla, M., Vasquez, R., et al. (2014). Treatment of childhood acute lymphoblastic leukemia in central America: A lower-middle income countries experience. PEDIATRIC BLOOD & CANCER, 61(5), 803-809 [10.1002/pbc.24911].
Navarrete, M; Rossi, E; Brivio, E; Carrillo, J; Bonilla, M; Vasquez, R; Peña, A; Fu, L; Martinez, R; Espinoza, C; Lacayo, L; Rodriguez, H; Batista, R; Barr, R; Howard, S; Ribeiro, R; Masera, G; Biondi, A; Conter, V; Valsecchi, M
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/50897
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