2014, Number 2
Survival in Children with Acute Lymphoblastic Leukemia, Treated in Base to Immune Risk Factors.
Full text
Language: Spanish
References: 21
Page: 90-95
PDF size: 284.22 Kb.
ABSTRACT
Introduction: Cancer is the second leading cause of death in the population 1-19 years in Mexico. It is estimated that annually 7000 new cancer cases occur in children under 20 years. Leukemia being the most frequent malignant disease of childhood (35%).Objectives: To know the survival of patients with LAL treated according to the stratification by risk groups based on prognostic factors current immunologic marker, in the period from 2008-2010.
Patients and Methods: This is a retrospective cohort study. Records were reviewed clinically, of all children with diagnosis of acute lymphoblastic leukemia were admitted in Oncology service during the period of 2008 to 2010 which meet the criteria for inclusion: studies immunologic diagnostics (immune, cytogenetic and DNA index, minimal Residual disease a week 5 ) characteristics, clinical and laboratory in order to group them according to risk factors.
Results: 54 patients admitted with diagnosis of acute lymphoblastic leukemia. Finding a higher incidence of male 39 children (72%), with a 8.3 average and deviation standard 4.8.Cytologicmorphologicfeatures62% corresponded to L2. The mediastinal lymphadenopathy was found in 9 (16.7%) and infiltration to CNS in 4 (7.5%). The good response to prednisone at day 7 was observed in 46 (85%). The bone marrow (BM) 14 days and week 5 found in complete remission in 20 (37%) and 46 (92%) respectively. The immunephenotype most prevalent was that of B cells in 46 (85%) and only 5 (9%) of T-cells also 85 were positive CALLA. Only 3 karyotype chromosome positive Ph (5.5%) was found were they classified risk low 22 (40.79%), 32 high risk (59.3%). The group studied global event-free survival was 75% to 5 years and groups according to prognostic factors event-free survival were 95% low-risk and high-risk 65% to 5 years.
Discussion: Analyzed prognostic factors: immune, karyotype, index DNA, CALLA and EMR allowed carrying out adequate risk stratification and adjusting therapy for treatment more optimal. So will intensify therapy in patients with high risk, with translocations unfavorable,EMR(+) at the end of the induction, with hypodiploidy or CALLA (-).
Conclusions: Therapy administered in our study we consider effective, especially for patients with 1.16 DNA index, Bcell, where was the 95 % SLE for the low-risk group, and 65 % the high-risk group.
REFERENCES
8.- Faith M. Uckun, Harland Sather, Paul Gaynon, Diane Arthur, James Nachman, Peter Steinherz, et al. Prognostic significance of the CD 10+, CD19+, CD 34+ B progenitor immunophenotype in children with acute lymphoblastic leukemia: a report from the Children‘s Cancer Group. Leuklymphoma. 1997; 27: 445-57.
9.- Trueworth R, Shuster, T. Look, W. Crist, M. Borowitz, A. Carroll, L. Frankel, M. Harris, H. Wagner, et al. Ploidy of lymphoblasts is the strongest predictor of treatment outcome in B progenitor cell acute lymphoblasti c leukemia of childhood: a Pediatric Oncology Group Study. J. Clin. Oncol. 1992; 10: 606-13.
11.- Moricke A, Reiter A, Zimmermann M, Gadner H, Stanulla M, Michael Dl, 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 ALL-BFM 95. Blood, 2008 (11); 9: pp 4477-89.