Armando Peña

Outcome of childhood acute lymphoblastic leukaemia in resource-poor countries

The causes of treatment failure in childhood acute lymphoblastic leukaemia are thought to differ between resource-rich and resource-poor countries. We assessed the records of 168 patients treated for this disease in Honduras. Abandonment of treatment (n=38), the main cause of failure, was associated with prolonged travel time to the treatment facility (2-5 h: hazard ratio 3.1, 95% CI 1.2-8.1 vs >5 h: 3.7, 1.3-10.9) and age younger than 4.5 years (2.6, 1.1-6.3). 35 patients died of treatment-related effects. Outcome could be substantially improved by interventions that help to prevent abandonment of therapy (such as funding for transport, satellite clinics, and support groups), and by prompt treatment of infection.

Asociación de Hemato-Oncología Pediátrica de Centro América (AHOPCA): a model for sustainable development in pediatric oncology.

Bridging the survival gap for children with cancer, between those (the great majority) in low and middle income countries (LMIC) and their economically advantaged counterparts, is a challenge that has been addressed by twinning institutions in high income countries with centers in LMIC. The long‐established partnership between a Central American consortium—Asociación de Hemato‐Oncología Pediátrica de Centro América (AHOPCA)—and institutions in Europe and North America provides a striking example of such a twinning program. The demonstrable success of this endeavor offers a model for improving the health outcomes of children with cancer worldwide. As this remarkable enterprise celebrates its 15th anniversary, it is appropriate to reflect on its origin, subsequent growth and development, and the lessons it provides for others embarking on or already engaged in similar journeys. Many challenges have been encountered and not all yet overcome. Commitment to the endeavor, collaboration in its achievements and determination to overcome obstacles collectively are the hallmarks that stamp AHOPCA as a particularly successful partnership in advancing pediatric oncology in the developing world. Pediatr Blood Cancer 2014;61:345–354.

Implementation of a data management program in a pediatric cancer unit in a low income country.

Pediatric cancer units in low‐income countries lack data on which to base quality improvement initiatives. We implemented a data management program in the oncology unit of the childrens hospital of Tegucigalpa, Honduras, and then we assessed training and supervision of data managers, data accuracy, and completeness as well as obstacles encountered.

A chemotherapy only therapeutic approach to pediatric Hodgkin lymphoma: AHOPCA LH 1999

AHOPCA is a collaborative group that designs uniform treatment regimens (protocols) for children diagnosed with cancer in Central America. Based on a preliminary report from one of the AHOPCA centers, AHOPCA adopted a treatment regimen to maintain a good event‐free survival (EFS) as well as eliminate radiation therapy from the treatment of children with Hodgkin lymphoma.

Mucormycosis Rhinosinusitis at Diagnosis of Acute Lymphoblastic Leukemia: Diagnostics and Management Challenges in a Low-Middle-income Country.

We present the case of an adolescent with mucor rhinosinusitis diagnosed concomitantly with acute lymphoblastic leukemia at a hospital in Tegucigalpa, Honduras. We also discuss the challenges faced in the dual management of hematologic malignancies and invasive fungal disease in a low–middle-income country, such as access to diagnostics, immunosuppressants, imaging, and antifungals. Despite these shortcomings, the patient was successfully treated for both the diseases. Low–middle-income country hospitals can effectively treat invasive fungal diseases by providing adequate diagnostic and support services, which can improve the outcomes of pediatric cancer patients.

Anaplastic Large Cell Lymphoma in Central America: A Report From the Central American Association of Pediatric Hematology Oncology (AHOPCA).

Although anaplastic large cell lymphoma (ALCL) is curable in high‐income countries (HIC), data from low‐ and middle‐income countries (LMIC) are lacking. We therefore conducted a retrospective study of the Central American Association of Pediatric Hematology Oncology (AHOPCA) experience in treating ALCL.

An Analysis of Treatment Failure in Wilms Tumor (WT): A Report from the Central American Association of Pediatric Hematology/Oncology (AHOPCA)

Abstract 57Background:Patients with WT in AHOPCA present late with large abdominal masses, in poor clinical condition. This analysis focuses on treatment failure.Methods:Between 2012 and 2015, 182 evaluable patients were diagnosed with unilateral WT. Patients were staged with abdominal ultrasound/computed tomography and thorax radiograph/CT. Therapy was adapted from National Wilms Tumor Study-5 except for patients with large abdominal masses and/or severe malnutrition who received preoperative doxorubicin, vincristine, actinomycin-D for 4 to 6 weeks. Treatment failure was defined as abandonment of therapy, recurrent/progressive disease (PD), and death: early ( 2 weeks after diagnosis).Results:49% were male; 23% were <2 years (median age 3.5y). Stage distribution: I, 8; II, 21; III, 116; IV, 37 cases. For 123/181 (68%) preoperative therapy was warranted (volume 579cm3). Treatment failures were: recurrence/PD 28; abandonment 19; early death 3, and toxic death 2. 2/29 (7%...