ABSTRACT
BACKGROUND: Iraq's health care system has gradually declined after several decades of wars, terrorism, and UN economic sanctions. The Oncology Unit at Children's Welfare Teaching Hospital (CWTH) in Baghdad was lacking basic facilities and support. To address this shortcoming, a humanitarian and educational partnership was established between CWTH and Sapienza University of Rome (SUR). METHODS: We investigated the outcomes of 80 online and 16 onsite educational sessions and 142 teleconsultation sessions from 2006 to 2014. We also determined the outcomes of pathology reviews by SUR of 1216 tissue specimens submitted by CWTH from 2007 until 2019 for second opinions. The primary outcomes were discordance, concordance, and changes among clinical diagnoses and pathology review findings. The measures included the frequency of teleconsultation and tele-education sessions, the topics discussed in these sessions, and the number of pathology samples requiring second opinions. FINDINGS: A total of 500 cases were discussed via teleconsultations during the study period. The median patient age was 7 years (range, 24 days to 16·4 years), and the cases comprised 79 benign tumors, 299 leukemias, 120 lymphomas, and 97 solid tumors. The teleconsultation sessions yielded 27 diagnostic changes, 123 confirmed diagnoses, and 13 equivocal impacts. The pathology reviews by SUR were concordant for 996 (81·9%) cases, discordant for 186 (15·3%), and inconclusive for 34 (2·8%). The major cause of discordance was inadequate immunohistochemical staining. The percentage of discordance markedly decreased over time (from 40% to 10%). The cause of the improvement is multifactorial: training of two CWTH pathologists at SUR, better immunohistochemical staining, and the ongoing clinical and pathologic telemedicine activities. The partnership yielded 12 publications, six posters, and three oral presentations by CWTH investigators. INTERPRETATION: The exchange of knowledge and expertise across continental boundaries meaningfully improved the diagnoses and management of pediatric cancer at CWTH.
Subject(s)
Neoplasms , Telemedicine , Child , Humans , Infant, Newborn , Iraq , Neoplasms/diagnosis , Neoplasms/epidemiology , Neoplasms/therapy , Delivery of Health Care , Medical OncologyABSTRACT
OBJECTIVE: The aim: To assess the outcome of allogeneic transplant regarding the overall Survival (OS) and main predictors can effect the survival of such patients. PATIENTS AND METHODS: Materials and methods: The records of seventy-nine Iraqi patients diagnosed with non-promyelocytic AML, who underwent allogeneic bone marrow transplantation outside of Iraq between 2012 and 2019, had been reviewed. The information had been collected from the data available in Bone Marrow Transplant Centre in Baghdad Medical City. Overall survival had been calculated by Kaplan-Meier Method. Patients included in the study are those who were diagnosed with acute myeloid leukemia according to French American British classes with the exclusion of acute promyelocytic leukemia (M3), who were allotransplanted for being diagnosed with high risk cytogenetic, refractory to chemotherapeutic regimen, relapsed after achieving complete remission, secondary to transformation from other myeloid malignancies or remaining with positive measurable residual disease after treatment. RESULTS: Results: The overall survival for 1 year, 2 years and 3 years were 63.20%, 55.09% and 46.58% respectively. The pre-transplanted factors found, no significant difference in overall survival regarding age, gender, extra medullary involvement. The transplant related criteria like stem cell source, presence of infection and type of conditioning regimen and incidence of any post-transplant complications do not predict overall survival apart from chronic graft versus host disease. Chronic GVHD were found to be significantly affecting overall survival. CONCLUSION: Conclusions: The most common cause of death was disease relapse. Iraqi AML patients who were treated with allogeneic bone marrow transplant had shown to have encouraging overall survival.
