Secular trends and predictors of mortality in acute lymphoblastic leukemia for children of low socioeconomic level in Northeast Brazil.

BACKGROUND: The treatment for ALL has evolved in recent decades and as a result survival rates are now close to 90% in many developed countries. However, this is not the case in developing countries where survival rates are often below 35%. More than 80% of children who are affected by ALL worldwide live in developing countries. The objective of this study was to evaluate the secular trend in mortality for children with ALL living in Sergipe, a state in northeastern Brazil, and to investigate any association with variables that relate to socioeconomic status. METHOD: This study evaluated ALL patients who were less than 20 years of age and who were treated at the Dr. Osvaldo Leite Oncology Center in the capital city, Aracaju. The sample comprised two cohorts of patients from the public health service: patients treated from 1980 to 2004 (cohort A) and from 2005 to 2014 (cohort B). The findings were compared to those of patients treated in the one private service for pediatric cancer treatment available in the region, from 2005 to 2014 (cohort C). Two categories of variables were considered in this study: biological and socioeconomic. RESULTS: We analyzed 412 patients who were divided into three cohorts (cohort A: 287 patients, cohort B: 106 patients and cohort C: 19 patients). The mortality rates for the three cohorts were significantly different: 57.5% in cohort A, 45.3% in cohort B and 26.3% in cohort C (p=0.006). Mortality during induction in cohort B was 22.6%, while in cohort C no deaths occurred during this phase (p=0.041). Patients living in rural areas had higher mortality rates (p=0.036). CONCLUSIONS: The reduction in deaths from infection during induction seems to be the starting point for improving the chances for children and adolescents with ALL anywhere in the world.

Steroid-induced ocular hypertensive response in children and adolescents with acute lymphoblastic leukemia and non-Hodgkin lymphoma.

The aim of this study was to evaluate intraocular pressure (IOP) associated with use of glucocorticoids in children and adolescents treated for acute lymphoblastic leukemia and non-Hodgkin lymphoma. We carried out a prospective descriptive study with measurement of IOP before treatment (D0), 8th (D8), 14th (D14), and 28 h days (D28) of treatment. We examined 12 patients, with two cases of ocular hypertension, and it was found a statistically significant difference between the means of IOP between D0 versus D8 and D0 versus D14 (P = 0.013). The possibility of silent ocular hypertension with irreversible blindness indicates the need of IOP verification.

Antibody responses to Hepatitis B and measles-mumps-rubella vaccines in children who received chemotherapy for acute lymphoblastic leukemia.

OBJECTIVE: To evaluate viral vaccine antibody levels in children with acute lymphoblastic leukemia after chemotherapy and after vaccine booster doses. METHODS: Antibody levels against hepatitis B, rubella, measles and mumps vaccine antigens were evaluated in 33 children after completing chemotherapy (before and after vaccine booster doses) and the results were compared to the data of 33 healthy children matched for gender, age and social class. RESULTS: After chemotherapy, 75.9%, 67.9%, 59.3% and 51.7% of the patients showed low antibody titers that would be unlikely to protect against exposure to measles, rubella, hepatitis B and mumps, respectively. After receiving a vaccine booster dose for these antigens the patients had high antibody levels consistent with potential protection against measles, mumps and hepatitis B, but not against rubella. CONCLUSION: Extra doses of measles-mumps-rubella plus hepatitis B vaccines are recommended in acute lymphoblastic leukemia patients submitted to treatment after hematologic recovery. After this, viral vaccine antibody levels should be verified to define the individual's protective status.

Antibody responses to Hepatitis B and measles-mumps-rubella vaccines in children who received chemotherapy for acute lymphoblastic leukemia

OBJECTIVE: To evaluate viral vaccine antibody levels in children with acute lymphoblastic leukemia after chemotherapy and after vaccine booster doses. METHODS: Antibody levels against hepatitis B, rubella, measles and mumps vaccine antigens were evaluated in 33 children after completing chemotherapy (before and after vaccine booster doses) and the results were compared to the data of 33 healthy children matched for gender, age and social class. RESULTS: After chemotherapy, 75.9%, 67.9%, 59.3% and 51.7% of the patients showed low antibody titers that would be unlikely to protect against exposure to measles, rubella, hepatitis B and mumps, respectively. After receiving a vaccine booster dose for these antigens the patients had high antibody levels consistent with potential protection against measles, mumps and hepatitis B, but not against rubella. CONCLUSION: Extra doses of measles-mumps-rubella plus hepatitis B vaccines are recommended in acute lymphoblastic leukemia patients submitted to treatment after hematologic recovery. After this, viral vaccine antibody levels should be verified to define the individual's protective status.