Poor Prognosis Biomolecular Factors Are Highly Frequent in Childhood Acute Leukemias From Oaxaca, Mexico.

OBJECTIVE: To investigate the cellular and molecular epidemiology of acute leukemias in vulnerable populations of children and adolescents in Oaxaca de Juarez, Mexico. MATERIAL AND METHODS: Descriptive, cross-sectional and retrospective study, conducted from 2014 to 2018 in which profiles of molecular and immunophenotypic aberrations were investigated in children and adolescents diagnosed with acute leukemia, by evaluating 28 molecular abnormalities by HemaVision-Q28 multiplex RT-PCR kit and standardized EuroFlow Immunophenotyping of bone marrow cells. RESULTS: We included 218 patients, with 82.5% younger than 14 years and 17.5% adolescents. The median age was 9 years and a main peak of incidence was recorded at age of 4 to 5 years. B-cell acute lymphoblastic leukemia was diagnosed in 70.64% of all cases, acute myeloid leukemia was in 22.48%, T-cell acute lymphoblastic leukemia in 6.42%, and mixed lineage acute leukemia in 0.46% of cases. Overall, chromosomal translocations were positive in 29.82% of cases. While 65.31% of patients with acute myeloid leukemia reported aberrancies, only in 18.83% of B-cell acute lymphoblastic leukemia cases genetic abnormalities were obvious. Surprisingly, most prevalent translocations in B-cell acute lymphoblastic leukemia were t(9;22) in 20.7%, followed by t(4;11) in 17.2% and t(6;11) in 13.8%, whereas patients with acute myeloid leukemia showed t(15;17) in 40.6% and t(8;21) in 21.9%. In contrast, an homogeneous expression of t(3;21) and t(6;11) was recorded for T-cell acute lymphoblastic leukemia and mixed lineage acute leukemia cases, respectively. Except for t(1;19), expressed only by pre-B cells, there was no association of any of the studied translocations with differentiation stages of the B-leukemic developmental pathway. CONCLUSION: Our findings identify near 50% of patients with acute lymphoblastic leukemia at debut with high-risk translocations and poor prognosis in B-cell acute lymphoblastic leukemia as well as an unexpected increase of acute myeloid leukemia cases in young children, suggesting a molecular shift that support a higher incidence of poor prognosis cases in Oaxaca.

[Allergies as a target of interest in the era of immunotherapy]. / Las alergias como blanco de interés en la era de la inmunoterapia.

Exacerbated immune system reactions often trigger allergy pathologies, which include asthma, rhinitis, urticaria, food and drug allergies, insect bites, and may sometimes have fatal outcomes. In Mexico, more than 20% of open population, present allergic symptoms with notable increase in the last twenty years, especially in children. The Mexican Institute for Social Security (IMSS, according to its initials in Spanish) provides attention to around 7000 patients per year, mainly due to allergies deriving from therapeutic drugs and certain foods. Pharmacotherapy has been effective in reducing classical allergy symptoms, although treatment does not stop disease progression. In addition, the constant use of drugs represents a remarkable socioeconomic impact. Strategies based on the modification of immune responses in the course of allergic reactions through immunotherapy started more than 100 years ago, and some have provided cure to the disease. On the occasion of the Nobel Prize in Physiology or Medicine 2018, it was awarded to James P. Allison and Tasuku Honjo for their contributions in the regulation of the immune system against cancer, through a new generation of immunotherapy. In this review we analyzed current immunotherapeutic options, including its benefits, limitations and perspectives for the best clinical management of allergies.

Las reacciones exacerbadas del sistema inmunológico a menudo disparan patologías por cuadros alérgicos que, entre otros, incluyen asma, rinitis, urticaria, alergia a alimentos, fármacos y picaduras de insectos, y en ocasiones tienen desenlaces fatales. En México, más del 20% de la población general presenta cuadros alérgicos, con un notable incremento en los últimos veinte años, especialmente en la población pediátrica. Tan solo el Instituto Mexicano del Seguro Social (IMSS) atiende alrededor de 7000 pacientes por año, principalmente por alergias a medicamentos y algunos alimentos. La farmacoterapia ha sido muy efectiva en la disminución de los síntomas, aunque el tratamiento no detiene la progresión de la enfermedad. Además, el uso constante de fármacos representa un remarcable impacto socioeconómico. Las estrategias basadas en la modificación de respuestas inmunes en el curso de las reacciones alérgicas a través de inmunoterapia comenzaron hace más de 100 años y algunas de ellas han dado solución a este grupo de padecimientos. En ocasión de la entrega del Premio Nobel de Medicina y Fisiología 2018, este fue otorgado a los doctores James P. Allison y Tasuku Honjo por sus contribuciones en la regulación del sistema inmune contra el cáncer, por medio de una nueva generación de inmunoterapia. En esta revisión analizamos las opciones inmunoterapéuticas actuales e incluimos sus beneficios, limitantes y perspectivas para el mejor manejo clínico de las alergias.