Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Antineoplastic Protocols/standards , Leukemia, Myeloid, Acute/therapy , Adolescent , Central Nervous System Neoplasms/prevention & control , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Infant , Infant, Newborn , Leukemia, Myeloid, Acute/mortality , Male , Remission Induction/methods , Survival Analysis , Treatment OutcomeABSTRACT
BACKGROUND: The National Chilean Pediatric Oncology Group, PINDA, reports the first prospective, nonrandomized trial for acute lymphoblastic leukemia (ALL), using a modified version of the Berlin-Frankfurt-Munster protocol (ALL BFM 86). The aim of this study was to classify immunophenotypes, to decrease cranial irradiation, and to assess whether this protocol would improve the survival rate. PROCEDURE: From June, 1987, to June, 1992, 444 unselected children were diagnosed with ALL. Of them, 425 were evaluable. Therapy was stratified by risk. Standard-risk (SR) and high-risk (HR) patients received protocols I, M, II, and maintenance therapy. Very-high-risk (VHR) patients received protocol E instead of protocol M. All patients received a prephase treatment consisting of prednisone and intrathecal methotrexate (MTX). HR and VHR patients received cranial irradiation (12-18 Gy). The following changes were made to the ALL BFM 86 protocol: in protocol M, MTX 1 g/m2 instead of 5 g/m2; in protocol E, citarabine 1 g/m2 instead of 2 g/m2; mithoxantrone and ifosfamide were substituted by teniposide and cyclophosphamide. RESULTS: Immunophenotypes: pro-B-ALL, 14%; common ALL, 67.4%; pre-B-ALL, 4.3%; T-ALL, 10%; undifferentiated leukemia (AUL), 4.3%. The overall 5-year event-free survival (EFS) rate was 60% +/- 2% (SE). The 5-year EFS rate for each risk group was: SR 75%, HR 62%, VHR 28%, with a median follow-up of 6.5 years (range 4.5-9.5 years). The cumulative incidence of central nervous system (CNS) relapse was 5.4%. CONCLUSIONS: We have been able successfully to perform a nationwide study. Our strategy to adapt the BFM protocol to our population of patients trial was effective in improving the EFS. The immunophenotype distribution is similar to that in other reported series.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Adolescent , Asparaginase/therapeutic use , Child , Child, Preschool , Chile , Combined Modality Therapy , Cranial Irradiation , Cyclophosphamide/therapeutic use , Cytarabine/therapeutic use , Developing Countries , Female , Humans , Immunophenotyping , Infant , Male , Mercaptopurine/therapeutic use , Methotrexate/therapeutic use , Precursor Cell Lymphoblastic Leukemia-Lymphoma/immunology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/radiotherapy , Prednisone/therapeutic use , Prospective Studies , Survival Analysis , Vincristine/therapeutic useSubject(s)
Brain Diseases/parasitology , Chagas Disease/transmission , Granuloma/parasitology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy , Transfusion Reaction , Acute Disease , Animals , Brain Diseases/pathology , Child , Granuloma/pathology , Humans , Immunosuppression Therapy , Male , Trypanosoma cruzi/isolation & purificationSubject(s)
Carcinoma , Nasopharyngeal Neoplasms , Carcinoma/drug therapy , Carcinoma/pathology , Carcinoma/radiotherapy , Child , Cyclophosphamide/administration & dosage , Dacarbazine/administration & dosage , Doxorubicin/administration & dosage , Drug Administration Schedule , Humans , Male , Nasopharyngeal Neoplasms/drug therapy , Nasopharyngeal Neoplasms/pathology , Nasopharyngeal Neoplasms/radiotherapy , Vincristine/administration & dosageABSTRACT
Se presenta el caso de un nino de 12 anos, de sexo masculino portador de un carcinoma nasofaringeo. Clinicamente el tumor se manifesto como una adenopatia cervical asociada a ptosis palpebral, atrofia parcial de la lengua y paralisis de las cuerdas vocales, todos en el lado correspondiente a al masa cervical. El paciente recibio tratamiento con quimio y radioterapia, observandose una respuesta inicial favorable, con remision de los sintomas y una posterior recaida con metastasis cerebrales que provocaron su muerte. Se destaca la importancia de considerar a este tipo de tumores en el diagnostico diferencial de masas cervicales benignas y malignas.Dentro de este ultimo grupo se enfatiza el diagnostico diferencial con el grupo de linfomas, por ser su pronostico y tratamiento diferentes
Subject(s)
Child , Humans , Male , Nasopharyngeal Neoplasms , Drug Administration ScheduleSubject(s)
Purpura, Thrombocytopenic/epidemiology , Age Factors , Blood Cell Count , Chile , Female , Humans , Infant , Male , Platelet Count , Sex FactorsABSTRACT
Se estudiaron 7 casos de PTI en lactantes menores de 4 meses. Se destaca su alta frecuencia en nuestro Pais, con distribucion en pequenos brotes epidemicos sindrome clinico inicial alarmante por la intensidad de las manifestaciones hemorragiparas de piel y mucosas, pero de evolucion muy benigna, acompanada de normalizacion clinica y de laboratorio en 2 o 3 semanas desde el inicio de la enfermedad. El estudio de las causas mas probables en menores de 4 meses, utilizando serologia para citomegalovirus, rubeola, herpes simplex,toxoplasma, Chagas, lues y cultivos de orina para citomegalovirus resulto no compatible con enfermedad actual por estos agentes en los 7 casos. Se sugiere continuar el estudio de otras posibilidades etiologicas del trastorno
Subject(s)
Infant , Humans , Male , Female , Purpura, Thrombocytopenic , ChileSubject(s)
Antineoplastic Agents/administration & dosage , Leukemia, Lymphoid/drug therapy , Adolescent , Central Nervous System Diseases/prevention & control , Child , Child, Preschool , Cytarabine/administration & dosage , Drug Administration Schedule , Drug Therapy, Combination , Female , Follow-Up Studies , Humans , Leukemia, Lymphoid/radiotherapy , Male , Mercaptopurine/administration & dosage , Methotrexate/administration & dosage , Prednisone/administration & dosage , Thioguanine/administration & dosage , Vincristine/administration & dosageABSTRACT
Se analizaron 67 casos de leucemia linfoblastica diagnosticados en un lapso de 10 anos en el Hospital Arriaran-Paula Jaraquemada. Un 86,5% obtuvo una remision completa inicial.La principal causa del fracaso fue la infeccion.Los pacientes que no recibieron profilaxis del SNC o esta se realizo tardiamente,presentaron una mayor incidencia de recaida inicial meningea. El grupo de sujetos que recibio una terapia adecuada segun los conocimientos actuales, presento a los 5 anos un 44% de sobrevida y un 42% de remision completa continuada. El subgrupo que recibio una tercera droga en la induccion obtuvo un 82% de remision completa continuada a los 3 anos. Un recuento de leucocitos> 20.000/mm3 se asocio a una evolucion desfavorable. La edad no constituyo un factor pronostico
