Outcome of adolescents and young adults with acute lymphoblastic leukemia in a single center in Brazil

Aguiar, Thais Ferraz; Barbosa, Thayana da Conceição; Maciel, Ana Luiza Tardem; Blunck, Caroline Barbieri; Sellos-Laclette, João; Melo, Andréia Cristina de; Mansur, Marcela Braga; Emerenciano, Mariana

doi:10.1016/j.htct.2022.06.006

Cited by 5 publications

(3 citation statements)

References 14 publications

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“…In Brazil, few centers perform these exams, so the material aspirated from the BM at diagnosis must be sent for analysis ( 34 ). Moreover, even in these reference laboratories, sometimes there is a lack of materials to perform these exams ( 35 , 36 ).…”

Section: Discussionmentioning

confidence: 99%

Association of the clinical profile and overall survival of pediatric patients with acute lymphoblastic leukemia

Correa,

Silva,

Mendes

et al. 2023

Front. Pediatr.

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IntroductionThe clarification of etiopathology, the improvement of chemotherapy regimens and their risk stratifications, and the improvement in treatment support have increased the survival of children and adolescents affected by Acute Lymphoblastic Leukemia (ALL) past few years. This study aimed to estimate overall survival (OS) and event-free survival (EFS) in an onco-hematology treatment center in Brazil, reports the main clinical-laboratory characteristics of patients at diagnosis, verify the frequency of treatment-related adverse effects and the main causes of death.Material and methodsRetrospective analysis involving patients diagnosed with ALL, treated with the protocol of the Brazilian Group for Treatment of Leukemias in Childhood (GBTLI), between 2010 and 2020 was carried out; the outcomes (relapse, deaths, development of new neoplasms) were analyzed SPSS® software was used for the statistical analyses, and the p-value was considered significant when less than 0.05 for all analyses.Results109 patients were included in the study; the median age was 5 years, with a slight predominance of males. Sixty-six patients were classified as high-risk (HR) group and 43 patients were classified as low-risk (LR) group. After 5 years of diagnosis, the OS was 71.5%, and the EFS was 65%. No statistical difference was found between the HR and LR groups for OS and EFS, while leukocyte counts were statistically associated with the outcome of death (p = 0.028). Among the patients, 28 (25.6%) died due to infection accounting 46.4% of death causes. Among the 34 patients with unfavorable outcomes (death and/or relapse), 32 had no research for the minimal residual disease at the end of remission induction, and 25 were not investigated for the presence of chromosomal abnormalities. The most reported complications and treatment-related adverse effects were increased liver transaminases (85.9%), airway infection (79.4%), oral mucositis (67.2%), febrile neutropenia (64.4%), and diarrhea (36.4%).ConclusionsThe rates of OS and EFS obtained in this cohort are similar to those obtained in the few previous similar studies in Brazil and lower than those carried out in developed countries. The unavailability of prognostic tests may have hindered risk stratification and influenced the results obtained.

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Section: Discussionmentioning

confidence: 99%

Association of the clinical profile and overall survival of pediatric patients with acute lymphoblastic leukemia

Correa,

Silva,

Mendes

et al. 2023

Front. Pediatr.

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“…Unfortunately, there are limited data available regarding the turnaround time for BCR-ABL1 testing in LMICs. Performing routine genetic testing for acute leukemia can pose challenges in certain healthcare centers [16,20,21]. A delayed detection of the Philadelphia chromosome can result in patients receiving general induction remission protocols without TKIs, and, regrettably, more intensive treatments than necessary for this patient population.…”

Section: Diagnostic Barriers In Lmicmentioning

confidence: 99%

How to Manage Philadelphia-Positive Acute Lymphoblastic Leukemia in Resource-Constrained Settings

Silva,

Rego

2023

Cancers

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Recent studies have indicated that more than half of adult patients newly diagnosed with Ph+ ALL can now achieve a cure. However, determining the most suitable protocol for less-resourced settings can be challenging. In these situations, we must consider the potential for treatment toxicity and limited access to newer agents and alloSCT facilities. Currently, it is advisable to use less intensive induction regimens for Ph+ ALL. These regimens can achieve high rates of complete remission while causing fewer induction deaths. For consolidation therapy, chemotherapy should remain relatively intensive, with careful monitoring of the BCR-ABL1 molecular transcript and minimal residual disease. AlloSCT may be considered, especially for patients who do not achieve complete molecular remission or have high-risk genetic abnormalities, such as IKZF1-plus. If there is a loss of molecular response, it is essential to screen patients for ABL mutations and, ideally, change the TKI therapy. The T315I mutation is the most common mechanism for disease resistance, being targetable to ponatinib. Blinatumomab, a bispecific antibody, has shown significant synergy with TKIs in treating this disease. It serves as an excellent salvage therapy, aside from achieving outstanding results when incorporated into the frontline.

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“…Results from AHOPCA-ALL 2008, a Berlin-Frankfurt-Münster (BFM)-based guideline, are well described (11,12). While countries such as Argentina, Chile, and Uruguay have participated in international, collaborative clinical trials as part of the ALL-IC BFM consortium (13,14) and Brazil has a longstanding record of national, multicenter randomized controlled clinical trials, however, the broad implementation and/or dissemination of similar multisite, evidence-based, and consensusderived systematic approaches from countries across the region is lacking (15)(16)(17)(18). As a result, in 2018, pediatric cancer centers in 5 countries in South America (Bolivia, Ecuador, Peru, Paraguay, and Venezuela) and St. Jude Children's Research Hospital (in the USA) formed the Pediatric Oncology of Latin America (POLA), a collaborative group aiming to improve outcomes for children with cancer in the region.…”

Section: Introductionmentioning

confidence: 99%

Retrospective analysis of outcomes for pediatric acute lymphoblastic leukemia in South American centers

Duffy,

Graetz,

Lopez

et al. 2023

Front. Oncol.

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IntroductionAcute lymphoblastic Leukemia (ALL) is the most common pediatric malignancy. While the survival rate for childhood ALL exceeds 90% in high-income countries, the estimated survival in low-and middle-income countries ranges from 22-79%, depending on the region and local resources.MethodsThis study retrospectively reviewed demographic, biological, and clinical parameters of children under 18 years of age with newly diagnosed ALL presenting between 2013-2017 across five pediatric centers in 4 countries in South America. Survival analyses were estimated using the Kaplan-Meier method.ResultsAcross the five centers, 752 patients were analyzed (Bolivia [N=9], Ecuador [N=221], Paraguay [N=197], Peru [N=325]) and 92.1% (n=690) patients were diagnosed with B-cell and 7.5% (n= 56) with T-cell ALL. The median age was 5.5 years old (IQR 7.29). At diagnosis, 47.8% of patients were categorized as standard and 51.9% as high risk per their institutional regimen. Advanced diagnostics availability varied between modalities. MRD was evaluated in 69.1% of patients; molecular testing was available for ETV6-RUNX, BCR-ABL1, TCF3-PBX1, and KMT2A-rearranged ALL in 75-81% of patients; however, karyotyping and evaluation for iAMP21 were only performed in 42-61% of patients. Central nervous system (CNS) involvement was evaluated at diagnosis in 57.3% (n=429) patients; of these, 93.7% (n=402) were CNS 1, 1.6% (n=7) were CNS 2, 0.7% (n=11) were CNS3, 1.9% (n=8) had cranial nerve palsy, and 2.1% (n=9) results unavailable. Chemotherapy delays >2 weeks were reported in 56.0% (n=421) patients during treatment. Delays were attributed to infection in 63.2% (n=265), drug-related toxicities in 47.3% (n=198), and resource constraints, including lack of bed availability in 23.2% (n=97) of patients. The 3-year Abandonment-sensitive EFS and OS were 61.0±1.9% and 67.2±1.8%, respectively. The 3-year EFS and OS were 71.0±1.8% and 79.6±1.7%, respectively.DiscussionThis work reveals opportunities to improve survival, including addressing severe infections, treatment interruptions, and modifications due to drug shortages. In 2018, healthcare professionals across South America established the Pediatric Oncology Latin America (POLA) group in collaboration with St. Jude Children’s Research Hospital. POLA collaborators developed an evidence-based, consensus-derived, adapted treatment guideline, informed by preliminary results of this evaluation, to serve as the new standard of care for pediatric ALL in participating institutions.

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Outcome of adolescents and young adults with acute lymphoblastic leukemia in a single center in Brazil

Cited by 5 publications

References 14 publications

Association of the clinical profile and overall survival of pediatric patients with acute lymphoblastic leukemia

Association of the clinical profile and overall survival of pediatric patients with acute lymphoblastic leukemia

How to Manage Philadelphia-Positive Acute Lymphoblastic Leukemia in Resource-Constrained Settings

Retrospective analysis of outcomes for pediatric acute lymphoblastic leukemia in South American centers

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