Expert Recommendations for the Diagnosis, Treatment, and Management of Adult B-Cell Acute Lymphoblastic Leukemia in Latin America.

PURPOSE: Despite strong induction chemotherapy response rates, only 30%-40% of patients with adult B-cell acute lymphoblastic leukemia (ALL) attain long-term remission. This study analyzes ALL in Latin America (LA) and recommends diagnosis, treatment, and management protocols. METHODS: The Americas Health Foundation organized a panel of hematologists from Argentina, Brazil, Chile, Colombia, and Mexico to examine ALL diagnosis and therapy and produce recommendations. RESULTS: Lack of regional data, unequal access to diagnosis and therapy, inadequate treatment response, and uneven health care distribution complicate adult ALL management. The panel recommended diagnosis, first-line and refractory treatment, and post-transplantation maintenance. Targeted treatments, including rituximab, blinatumomab, and inotuzumab ozogamicin, are becoming available in LA and must be equitably accessed. CONCLUSION: This review adapts global information on treating ALL to LA. Governments, the medical community, society, academia, industry, and patient advocates must work together to improve policies.

Assessment and Impact of Phase Angle and Sarcopenia in Palliative Cancer Patients.

Sarcopenia has been evaluated as a separate condition in cancer patients and as an important indicator of adverse outcomes. Muscle mass and phase angle are usually quantified by bioelectrical impedance analysis, due to its lower cost, and availability. The aim of this study was to assess the impact of sarcopenia, phase angle, and other characteristics on overall survival (OS) in palliative cancer patients at the National Cancer Institute of Mexico. We enrolled 628 patients (female, 59%). The most frequent disease was gastric cancer (39.5%). Kaplan-Meier analysis showed a significant survival disadvantage for patients with sarcopenia compared to patients without sarcopenia (p = 0.02). Sarcopenia univariably predicted OS [HR 1.4 (95% CI, 1.1-1.8), p = 0.001], but was not significant in multivariable Cox-regression analysis (p = 0.08). Significant predictors for sarcopenia in multivariable Cox-regression analysis were sex, age, body mass index, phase angle, clinical symptoms, and Karnofsky. Our results corroborate the reliability of sarcopenia and phase angle in Mexican population, showing that the measurement of these parameters might also be useful in early-stage cancer patients as prognostic markers.

Phase Angle of Bioelectrical Impedance Analysis as Prognostic Factor in Palliative Care Patients at the National Cancer Institute in Mexico.

Patients with advanced cancer often experience symptoms of disease and treatment that contribute to distress such as weight loss, which is present in up to 85% of cancer patients. Palliative care in these patients focuses on care aimed at improving quality of life. Phase angle (PA) is obtained by bioelectric impedance analysis (BIA) and is associated with cellular function. It is considered a reliable marker of malnutrition. A low PA may suggest deterioration of the cell membrane, which in palliative patients may result in a short-term survival. The aim of this study was to associate PA and survival in palliative patients of the National Cancer Institute of Mexico. We included 452 patients (women, 56.4%); the average PA was 4.0°. The most frequent disease was gastric cancer (39.2%). Mean body mass index (BMI) was 22.84. The average survival of patients with PA ≤ 4° was 86 days, while in the group with PA > 4°, it was 163 days (P > 0.0001). PA showed significant positive correlation with survival time and BMI. Our results corroborate the reliability of PA in Mexican population, as an indicator of survival in palliative care patients compared to the reported literature in other countries.