Complicaciones asociadas y análisis de supervivencia de niños con leucemias agudas tratados con el protocolo BFM-95

Complicaciones asociadas y análisis de supervivencia de niños con leucemias agudas tratados con el protocolo BFM-95

Julio Alejandro Peña, Jesús Andrés Pantoja, Ángela Milena Acosta, Elehonora Argotty Pérez, Ana Cristina Mafla

Resumen

Resumen

Objetivo: Determinar las complicaciones y porcentaje de supervivencia de niños con leucemia linfoide y mieloide aguda tratados con el protocolo Berlin-Frankfurt-Münster 95 (BFM-95) de Enero de 2008 a Diciembre de 2010 en el Hospital Infantil “Los Ángeles”.

Materiales y métodos: Una cohorte retrospectiva fue diseñada para evaluar a niños tratados con el protocolo BFM-95 durante tres años en el Hospital Infantil “Los Ángeles”. La información fue obtenida de los datos demográficos del paciente, complicaciones asociadas con el protocolo BFM-95 y supervivencia. Los datos fueron recolectados de las historias médicas y los reportes de fallecimiento del hospital. Las variables nominales fueron presentadas como proporciones y las variables continuas fueron expresadas como medias y desviaciones estándares. El análisis de supervivencia fue realizado por el método Kaplan-Meier. Los datos fueron analizados usando el programa Statistical Package for Social Sciences, versión 17,0 (SPSS Inc., Chicago, Illinois, USA).

Resultados: Cincuenta y dos niños fueron incluidos en este estudio. De todo el grupo, 47 (90,4%) tuvieron leucemia linfoide aguda y 5 (9,6%) leucemia mieloide aguda. Treinta y cinco (67,3%) presentaron complicaciones. Veintitres niños (65,7%) mostraron complicaciones infecciosas siendo las más frecuentes. El análisis de supervivencia de Kaplan-Meier mostró que los pacientes con complicaciones tuvieron un tiempo más corto de supervivencia comparado a los pacientes sin complicaciones.

Conclusiones: La incidencia de complicaciones fue elevada. El análisis Kaplan-Meier reveló diferencias entre la leucemia linfoide aguda y leucemia mieloide aguda de acuerdo a las complicaciones.

 Abstract

Objective: To determine complications and survival percentage in children suffering from acute lymphoid and myeloid leukemia treated with Berlin-Frankfurt-Münster 95 (BFM-95) protocol from January 2008 to December 2010 at Los Ángeles Children Hospital.

Materials and methods: A retrospective cohort was designed to evaluate children treated with BFM-95 protocol during three years at Los Ángeles Children Hospital. The Information was obtained from the patient demographics, complications associated with BFM-95 protocol and survival. Data were collected from medical records and hospital decease reports. Nominal variables were presented as proportions and the continuous variables were presented as means and standard deviations. The survival analysis was performed using Kaplan-Meier method. Data were analyzed using the Statistical Package for Social Sciences, 17.0 version software (SPSS Inc., Chicago, Illinois, USA).

Results: Fifty two children were included in this study. From the whole group, 47 (90.4%) had acute lymphoid leukemia and 5 (9.6%) had acute myeloid leukemia. Thirty five (67.3%) presented complications. Twenty three children (65.7%) had infectious complications, being the most frequent ones. Kaplan-Meier survival analysis showed that patients with complications have shorter survival time compared to patients with no complications.

Conclusions: The incidence of complications was high in children treated with BFM-95 protocol. Kaplan-Meier analysis revealed differences between acute lymphoid leukemia and acute myeloid leukemia according to complications.

 

Palabras clave

Leucemia linfoide aguda; leucemia mieloide aguda; niño; complicaciones; análisis de supervivencia; epidemiología; Acute lymphoid leukemia; acute myeloid leukemia; child; complications; survival analysis; epidemiology

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Referencias

Margolin J, Poplack D. Acute lymphoblastic leukemia. In: Principles and Practice of Pediatric Oncology (Pizzo P, Poplack D, eds). Philadelphia: Lippincott-Raven; 1997. pp. 409-462.

National Cancer Institute. Childhood Acute Lymphoblastic Leukemia Treatment (PDQ®). [Online]. Citado en 2011. [fecha de acceso: 17 de Junio de 2011]. Disponible en URL: http://www.cancer.gov/cancertopics/pdq/treatment/childALL/Patient/page1

National Cancer Institute. Childhood Acute Myeloid Leukemia/Other Myeloid Malignancies Treatment. [Online]. Citado en 2010. [fecha de acceso: 17 de Junio de 2011]. Disponible en URL: http://www.cancer.gov/cancertopics/pdq/treatment/childAML/Patient/page1#Keypoint4

Parkin DW, Stiller CA. Childhood cancer in developing countries: Environmental factors. Int J Pediatr Hematol Oncol 1995; 2:411-417.

Ferlay J, Bray F, Pisani P, Parkin DM. GLOBOCAN 2002 Cancer Incidence, Mortality and Prevalence Worldwide IARC Cancer Base No. 5, version 2.0 IARC Press, Lyon, 2004.

Ministerio de Protección Social. Instituto Nacional de Salud. Instituto Nacional de Cancerología. Protocolo de vigilancia centinela en salud pública de las leucemias agudas pediátricas. [Online]. Citado en 2005. [fecha de acceso: 16 de mayo de 2011]. Disponible en URL: http://www.dssa.gov.co/index.php/salud-publica/protocolos

Belson M, Kingsley B, Holmes A. Risk factors for acute leukemia in children: A review. Environ Health Perspect. 2007; 115:138-145.

Christensen MS, Heyman M, Möttönen M, Zeller B, Jonmundsson G, Hasle H; Nordic Society of Paediatric Haematology and Oncology (NOPHO). Treatment-related death in childhood acute lymphoblastic leukaemia in the Nordic countries: 1992-2001. Br J Haematol 2005; 131:50-58.

Pui CH, Howard SC. Current management and challenges of malignant disease in the CNS in paediatricleukaemia. Lancet Oncol 2008; 9: 257- 268.

Hijiya N, Liu W, Sandlund JT, Jeha S, Razzouk BI, Ribeiro RC, et al. Overt testicular disease at diagnosis of childhood acute lymphoblastic leukemia: lack of therapeutic role of local

irradiation. Leukemia 2005;19 :1399-1403.

Hann I, Viscoli C, Paesmans M, Gaya H, Glauser M. A comparison of outcome from febrile neutropenic episodes in children compared with adults: results from four EORTC studies.

International Antimicrobial Therapy Cooperative Group (IATCG) of the European Organization for Research and Treatment of Cancer (EORTC). Br J Haematol 1997; 99: 580–588.

Molgaard-Hansen L, Möttönen M, Glosli H, Jónmundsson GK, Abrahamsson J, Hasle H; Nordic Society of PaediatricHaematology and Oncology (NOPHO). Treatment-related deaths in second complete remission in childhood acute myeloid leukaemia. Br J Haematol 2011; 152:623-630.

Lehrnbecher T, Varwig D, Kaiser J, Reinhardt D, Klingebiel T, Creutzig U. Infectious complications in pediatric acute myeloid leukemia: analysis of the prospective multi-institutional clinical trial AML-BFM 93. Leukemia. 2004; 18:72-77.

Portwine C, Mitchell D, Johnston D, Gillmeister B, Ethier MC, Yanofsky R, et al. Infectious events prior to chemotherapy initiation in children with acute myeloid leukemia. PLoS One. 2013; 8:e61899.

Creutzig U, Zimmermann M, Reinhardt D, Dworzak M, Stary J, Lehrnbecher T. Early deaths and treatment-related mortality in children undergoing therapy for acute myeloid leukemia: analysis of the multicenter clinical trials AML BFM 93 and AML-BFM 98. J Clin Oncol. 2004; 22:4384-4393.

Veringa SJ, van Dulmen-den Broeder E, Kaspers GJ, Veening MA. Blood pressure and body composition in long-term survivors of childhood acute lymphoblastic leukemia. Pediatr Blood Cancer. 2012; 58:278-282.

Fulbright JM, Raman S, McClellan WS, August KJ. Late effects of childhood leukemia therapy. Curr Hematol Malig Rep. 2011; 6:195-205.

Molgaard-Hansen L, Möttönen M, Glosli H, Jónmundsson GK, Abrahamsson J, Hasle H; Nordic Society of Paediatric Haematology and Oncology (NOPHO). Early and treatment-related

deaths in childhood acute myeloid leukaemia in the Nordic countries: 1984-2003. Br J Haematol. 2010;151:447-459.

Möricke A, Reiter A, Zimmermann M, Gadner H, Stanulla M, Dördelmann M, et al. Risk-adjusted therapy of acute lymphoblastic leukemia can decrease treatment burden and improve survival: treatment results of 2169 unselected pediatric and adolescent patients enrolled in the trial ALLBFM 95. Blood. 2008;111:4477-4489.

Magyarosy E. Hungarian experience in the treatment of childhood acute lymphoblastic leukemia. Magy Onkol. 2000;44:255-259.

Ministerio de Protección Social. Instituto Nacional de Salud. Instituto Nacional de Cancerología. Protocolo de vigilancia centinela en salud pública de las leucemias agudas pediátricas. Definiciones operativas y clasificación de casos para la vigilancia. [Online]. Citado en 2005. [fecha de acceso: 16 de Mayo de 2011]. Disponible en URL: http://www.dssa.gov.co/index.php/saludpublica/protocolos

Vardiman JW, Thiele J, Arber DA, Brunning RD, Borowitz MJ, Porwit A, Harris NL, Le Beau MM, Hellström-Lindberg E, Tefferi A, Bloomfield CD. The 2008 revision of the World Health Organization (WHO) classification of myeloid neoplasms and acute leukemia: rationale and important changes. Blood. 2009; 114:937-951.

Laks D, Longhi F, Wagner MB, Ramos-García PC. Survival evaluation of children with acue lymphobastic leukemia treated with Berlin- Frankfurt-Munich trial. J Pediatr (Rio J). 2003;79:149-158.

Shah A, Coleman MP. Increasing incidence of childhood leukaemia: A controversy re-examined. Br J Cancer. 2007; 97:1009 – 1012.

Smith MA, Seibel NL, Altekruse SF, Ries LA, Melbert DL, O’Leary M, Smith FO, Reaman GH. Outcomes for children and adolescents with cancer: challenges for the twenty-first century. J ClinOncol. 2010; 28:2625-2634.

Pérez-Saldivar ML, Fajardo-Gutiérrez A, Bernáldez-Ríos R, Martínez-Avalos A, Medina- Sanson A, Espinosa-Hernández L, et al. Childhood acute leukemias are frequent in Mexico City:

descriptive epidemiology. BMC Cancer. 2011; 11:355.

Müller J, Kovács G, Jakab Z, Rényi I, Galántai I, Békési A, et al. Treatment results with ALL-BFM-95 protocol in children with acute lymphoblastic leukemia in Hungary. Orv Hetil. 2005; 146:75-80.

Ross JA, Severson RK, Swensen AR, Pollock BH, Gurney JG, Robison LL. Seasonal variations in the diagnosis of childhood cancer in the United States. Br J Cancer. 1999; 81:549–553.

Harris RE, Harrell FE Jr, Patil KD, Al-Rashid R. The seasonal risk of pediatric/juvenile acute lymphocytic leukemia in the United States. J Chronic Dis. 1987;40:915-923.

Tang JY, Gu LJ. Report on induction efficacy of protocol ALL-2005 and middle term follow-up of 158 cases of childhood acute lymphoblastic leukemia. ZhonghuaXue Ye Xue ZaZhi. 2009;30:289-293.

Imaizumi M, Tawa A. Prospective study of a therapeutic regimen with all-trans retinoic acid and anthracyclines in combination of cytarabine in children with acute promyelocyticleukaemia: the Japanese childhood acute myeloid leukaemia cooperative study. Br J Haematol. 2011;152:89-98.

Ponce-Torres E, Ruíz-Rodríguez M del S, Alejo- González F, Hernández-Sierra JF, Pozos-Guillén Ade J. Oral manifestations in pediatric patients receiving chemotherapy for acute lymphoblastic leukemia. J ClinPediatr Dent. 2010;34:275-279.

Javed F, Utreja A, Bello-Correa FO, Al-Askar M, Hudieb M, Qayyum F, et al. Oral health status in children with acute lymphoblastic leukemia. Crit Rev Oncol Hematol. 2012;83:303-309.

Figliolia SL, Oliveira DT, Pereira MC, Lauris JR, Maurício AR, Oliveira DT, Mello de Andrea ML. Oral mucositis in acute lymphoblastic leukaemia: analysis of 169 paediatric patients. Oral Dis. 2008;14:761-766.

Kim H, Lee JH, Choi SJ, Lee JH, Seol M, Lee YS, et al. Risk score model for fatal intracranial hemorrhage in acute leukemia. Leukemia. 2006;20:770-776.

Green D. Management of bleeding complications of hematologic malignancies. Semin Thromb Hemost. 2007;33:427-434.

Athale UH, Chan AK. Hemorrhagic complications in pediatric hematologic malignancies. Semin Thromb Hemost. 2007;33:408-415.

Smith MA, Seibel NL, Altekruse SF, Ries LA, Melbert DL, O’Leary M, et al. Outcomes for children and adolescents with cancer: challenges for the twenty-first century. J Clin Oncol.

;28:2625-2634.

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