Background
Treating B–non‐Hodgkin lymphoma (B‐NHL) in lower‐income countries is challenging because of imprecise diagnosis, the increased risk of fatal toxicity associated with advanced disease at ...presentation, and limited supportive care.
Procedure
Central American patients with newly diagnosed stage I or II B‐NHL received a modified Berlin–Frankfurt–Münster (BFM) regimen including a prephase (prednisone, cyclophosphamide) followed by A/B/A courses (A: cytarabine, dexamethasone, etoposide, ifosfamide, methotrexate, and intrathecal therapy; B: cyclophosphamide, dexamethasone, doxorubicin, methotrexate, and intrathecal therapy). Those with stage III or IV NHL received additional courses (B/A/B), intensified for stage IV disease by additional vincristine and methotrexate doses. Patients in poor condition received a second prephase treatment before their chemotherapy courses.
Results
Between March 2004 and June 2016, of 405 patients with B‐NHL, 386 (109 females) were eligible for treatment. Immunohistochemistry was performed in 177 cases (47.4%) and characterized the disease as mature B‐cell lymphoma. Stage distribution was as follows: I/II, 31 (8.1%); III, 252 (65.3%); IV, 93 (24.1%); 10 (2.6%) not available. The 3‐year overall survival was 70% for the whole group (86% for stages I/II, 75% for stage III, 58% for stage IV). Events included death during induction (34 patients, 8.8%), relapse/progression (46, 11.9%), death in remission (9, 2.3%), second malignancy (1, 0.26%), and death of unknown cause (1, 0.26%). Twenty‐three (6%) patients abandoned or refused therapy.
Conclusions
Approximately 70% of children with B‐NHL from Central America experienced long‐term, disease‐free survival with a modified BFM schedule. Toxic death and relapse/resistant disease were the main reasons for treatment failure.
Background/objectives
High‐risk Hodgkin lymphoma (HRHL) in children is curable with combined modality therapy. The Association of Pediatric Hematology‐Oncology of Central America (AHOPCA) is a ...consortium of cancer centers from Central America. In 2004, AHOPCA implemented a guideline with a short course of chemotherapy (mStanfordV), strict diagnostics, and radiation guidelines, aimed at reducing abandonment and improving outcomes.
Methods
Newly diagnosed children less than 18 years of age with high‐risk HL (Ann Arbor stages: IIB, IIIB, IV) from AHOPCA centers were staged with chest radiography and ultrasound or computed tomography. Therapy was a modified Stanford V (mStanfordV), substituting cyclophosphamide for mechlorethamine and involved field radiation.
Results
Of 219 patients with HRHL, 181 patients were eligible and evaluable; 146 (81%) were boys, 22% being less than 6 years; 43 were stage IIB, 84 IIIB, and 54 IV. Thirty‐one (17%) abandoned therapy, 28 (15%) progressed, 30 (17%) relapsed, and eight (4%) died of toxicity. Radiation guidelines were not followed. Five‐year abandonment‐sensitive event‐free survival and overall survival (AS‐EFS, AS‐OS ± SE) for the cohort were 46% ± 4% and 56% ± 4%; 5‐year AS‐OS for stages IIB, IIIB, and IV was 76% ± 7%, 59% ± 7%, and 35% ± 7% (p = .0006).
Conclusion
Despite instituting a short treatment guideline, it did not improve the abandonment rate (17%) and did not achieve the reported outcomes of Stanford V. The cyclophosphamide dose used to replace merchlorethamine was inadequate. Despite strict guidelines, the radiation therapy application was inaccurate. Weekly chemotherapy may have adversely affected abandonment of therapy by increasing the burden of travel time. Based on these results, AHOPCA established a new abandonment strategy and a new guideline.
Medical and health system advances have brought cure to more than 80% of children with cancer in high-income countries (HICs),1 but such advances have eluded children in most LMICs, where inequities ...can yield cure percentages anywhere from 5% to 60%.2 Multiple factors contribute to the inadequate care of childhood cancers in LMICs, including resource scarcity, health system fragility, limited provider awareness, and absence of political attention.3 These conditions are abetted by a lack of sustained political attention to childhood cancer at the international level. Core functions of the Working Group include: (1) health system evidence development; (2) knowledge exchange and capacity building among country-level stakeholders; (3) knowledge translation for policy development on issues with regional scope; and (4) regional interface with national governments. Because of its collaboration between national Ministries of Health throughout the region, PAHO, the UICC, and North and South American academic partners, we believe that the Working Group is uniquely positioned to identify and promote effective strategies for policy reform and health system strengthening for children with cancer. Challenges Lessons Governance Insufficient governance capacity: absence of national childhood cancer plans, accreditation processes and treatment protocolsCompeting agendas in context of multiple needs divert attention from childhood cancer International collaboration as facilitator of knowledge translation for context-sensitive programmes and standardsBroad stakeholder engagement is key to increase political visibility of childhood cancer agenda Access to medicines Erratic supply of EML medicines for children with cancer: decentralised purchasing, weak procurement and supply management processes, and poor pharmacovigilance Role of PAHO Strategic...
Abstract 718
Hodgkin Lymphoma (HL) is highly curable with reported event-free survival (EFS) estimates of greater than 80% even in high-risk patients. Unfortunately, EFS of HL in low-income countries ...is much lower, about 50%. The Asociación de Hemato-Oncología Pediátrica de Centro América (AHOPCA) is a collaborative group that designs therapeutic guidelines (protocols) for the treatment of selected malignant disorders in Central America and the Dominican Republic. In 2004 AHOPCA designed a new protocol for the treatment of high-risk HL (stage IIB, IIIB and IV). The purpose of the protocol (AHOPCA LH 2004) was to provide proven effective therapy that would improve survival, decrease toxicity and decrease abandonment of therapy in this group of patients. Because of its short duration (12 weeks of chemotherapy) and reported efficacy, Stanford V was selected but modified to adapt to the local circumstances. We hereby report the preliminary results of AHOPCA LH 2004 which closed to accrual in April 2009.
All newly diagnosed biopsy proven HL patients Ann Arbor stages IIB, IIIB and IV, that presented within the seven AHOPCA centers between April 2004 and April 2009 were eligible. Treatment consisted of a modified Stanford V regimen with dose-equivalent cyclophosphamide substituting for nitrogen mustard since the latter was unavailable in Central America. Involved field radiation therapy (IFRT) was reduced from the original 35 Gy. Chemotherapy was given for 12 weeks without the use of growth factor support as follows: doxorubicin 25 mg/m2 and vinblastin 6 mg/m2 intravenous (IV) weeks 1,3,5,7,9 and 11; vincristine 1.4 mg/m2 (maximum 2 mg) and bleomycin 6 units/m2 IV weeks 2,4,6,8,10 and 12; cyclophosphamide 600 mg/m2 IV weeks 1,5 and 9; etoposide 60 mg/m2 IV daily for 2 days weeks 3,7 and 11; prednisone 40 mg/m2 (maximum 60 mg/day) orally given every other day weeks 1 through 10 with tapering of dose over weeks 11 and 12; Response evaluation with diagnostic imaging studies of the initially involved sites of disease was performed at the end of all prescribed chemotherapy. Patients that had achieved a complete response at that point received 20 Gy IFRT, patients with less than a complete response received 25 Gy. Trimethoprim and acyclovir prophylaxis was given to all patients. Patient data was collected and entered prospectively in POND, a web-based electronic data base, provided by St Jude Children's Research Hospital. Toxicities were recorded according to CTCAE 3.0.
221 patients were enrolled of which 206 were evaluable. Fifteen patients were excluded from the analysis for major protocol deviations. Male subjects predominated (79%) with a median age of 10 years (2-19). The risk distribution consisted of 49 (23%) stage IIB, 100 (48%) stage IIIB, 4 (2%) stage IVA and 50 (24%) stage IVB. Histological classification of HL was: nodular sclerosis 45%, mixed cellularity 42%, lymphocyte predominant 5%, lymphocyte depleted 2% and classical not otherwise specified 6%. The most important grade 3 and 4 toxicities were hematological (75%) and there were two grade 5 toxicities, one infectious and one pulmonary. EFS (±SE) at 3 years was 55.4 % (± 4.4), considering abandonment of therapy as an event, and the overall survival (±SE) was 75.1% (±4.2). Abandonment of therapy was 14.6% for the whole cohort, however it was worse for the largest cohort of patients, stage IIIB, 20%. EFS by stage was: stage IIB 79% (± 6%), IIIB 56% (± 7%) and IVB 29% (± 8%). Stage IVB patients clearly had the worse prognosis, however children < 5 years old had an excellent EFS of 90% regardless of stage or histology but a larger proportion had mixed cellularity HL (60%).
Our modified Stanford V is a well tolerated regimen with minimal toxicities that does not require growth factor support and can be delivered in an outpatient setting. However, the EFS of patients was less than expected for the group as a whole, (55.4%), and the abandonment rate still unacceptable despite the ease of administration. We have no clear explanation for the excellent survival of children <5 years of age. In our assessment, this treatment regimen is not an effective strategy for high-risk HL in our setting, possibly related to the treatment alterations from the original protocol, or because most of our patients present with more advanced disease than patients in high-income countries.
No relevant conflicts of interest to declare.
Abstract from Current Literature 38(3) Khaleque, Md Abdul; Hafiz, Md Golam; La Rosa, Cristian German Sanchez ...
Bangladesh journal of child health,
03/2015, Letnik:
38, Številka:
3
Journal Article
Abstract not available DOI: http://dx.doi.org/10.3329/bjch.v38i3.22831 Bangladesh J Child Health 2014; VOL 38 (3) :174-176
Ocular trauma is a health problem in the world today and a common cause of visual impairment leading to severe sequelae and psychological disorders. The case of a 46-year-old male patient who ...attended the Ophthalmology emergency services of the Dr. Gustavo Aldereguía Lima University General Hospital of Cienfuegos, recounting that while hammering iron on iron he felt that something entered his right eye, is presented. He suffered from pain, tearing, red eye and blurred vision. A penetrating scleral injury with an intraocular foreign body was diagnosed. Its study was conducted through biomicroscopy, orbital x-ray and ocular ultrasound. Surgical treatment by extracapsular lens extraction with intraocular lens implantation was performed using Blumenthal technique and pars plana approach for removal of the intraocular foreign body.
El trauma ocular constituye un problema de salud en el mundo actual y una causa común de deficiencia visual que deja en el paciente serias secuelas y trastornos psicológicos. Se presenta el caso de ...un paciente de 46 años, masculino, que acudió al cuerpo de guardia de Oftalmología del Hospital General Universitario Dr. Gustavo Aldereguía Lima de Cienfuegos, refiriendo que al estar martillando hierro sobre hierro sintió que algo se le proyectó a nivel del ojo derecho. Presentaba dolor, lagrimeo, ojo rojo y visión algo borrosa. Se le diagnosticó una herida penetrante escleral con cuerpo extraño intraocular. Se procedió al estudio que contempló biomicroscopia, radiografía de órbita y ultrasonido ocular. Se realizó tratamiento quirúrgico mediante extracción extracapsular del cristalino con implante de lente intraocular mediante la técnica de Blumenthal y abordaje a nivel de pars plana para la extracción del cuerpo extraño intraocular.
O presente artigo especifica os principais conceitos relacionados às táticas no kumite do karate da categoria escolar, portanto, é direcionado ao estudo da preparação tática, especificamente à ...determinação das ações ou fases das táticas, bem como à diferentes métodos de preparação tática, o pensamento deles e tático; a análise dos princípios para a avaliação das táticas nos esportes de oposição e a concepção dos diferentes tipos de kumite no karate-do, como aspectos mais complexos da preparação do karateca, que é de grande importância. Para tanto, foi necessário o uso de vários métodos de pesquisa, incluindo a análise de síntese, que permite analisar a literatura consultada e chegar a considerações sobre o assunto da mesma maneira que o uso da dedução por indução permitiu chegar a conclusões.
El presente artículo se precisan los principales conceptos relacionados con la táctica en el kumite del karate do categoría escolar, por consiguiente, va dirigido hacia el estudio de la preparación ...táctica, específicamente hacia la determinación de las acciones o fases de la táctica, así como los diferentes métodos de la preparación táctica, sus y pensamiento táctico; el análisis de los principios para la evaluación de la táctica en los deportes de oposición y la concepción de los diferentes tipos de kumite en el karate-do, como aspectos más complejos de la preparación del karateca, lo cual constituye de gran importancia. para el mismo fue necesario el empleo de varios métodos de investigación entre ellos el análisis síntesis el cual permite analizar la literatura consultada y llegar a consideraciones sobre el tema de igual manera el empleo de la inducción deducción permitió arribar a conclusiones.
El propósito de esta investigación, es el análisis y evaluación de las metodologías implementadas por el Distrito Capital para implementar los llamados "proyectos sociales" con el fin de establecer ...la influencia de la metodología en los resultados obtenidos de dichos proyectos. Para ello se hizo una selección de los proyectos asignados a la inversión y al gasto social a partir de las fichas EBI (Estadísticas Básicas de Información). Su análisis y evaluación se realizó con base en las reglas teóricas estándar de la Evaluación Ex Ante, definidas en los Manuales de uso frecuente por parte de las Entidades Multilaterales y Oficiales que aprueban dichos proyectos y asignan los recursos para su ejecución. De acuerdo con las 14 variables especificadas para que el proyecto cumpla con los parámetros definidos en el estándar, se encontró que casi todos los proyectos analizados adolecen de diagnósticos operativos de la situación sobre la que se quiere trabajar, no hay precisión ni se priorizan los objetivos en relación con las políticas sociales las inversiones, los costos y su factibilidad. Igualmente, se encontró que los proyectos no contemplan componentes que midan los impactos o indicadores que muestren el mejoramiento de la calidad de vida de las personas a quienes van orientados.
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