Luis Javier Marfil-Rivera

Real-world outcomes of treatment for acute lymphoblastic leukemia during adolescence in a financially restricted environment: Results at a single center in Latin America: Jaime-Pérez et al.

There is a paucity of the studies of adolescents with acute lymphoblastic leukemia (ALL). This is more noticeable in low‐ and middle‐income countries. The international 5‐year event‐free survival (EFS) and overall survival (OS) for this age group is around 80%, with pediatric‐inspired protocols offering better results.

Survival Rates of Adults With Acute Lymphoblastic Leukemia in a Low-Income Population: A Decade of Experience at a Single Institution in Mexico

Micro‐Abstract Adult acute lymphoblastic leukemia has an elevated mortality rate, with little improvement in recent decades. We studied 94 patients treated over 10 years in a low‐income population. Younger age, elevated high‐risk disease, and a high relapse rate were documented. However, overall survival after complete remission was close to that in industrialized countries. The cure threshold with current treatment approaches has been reached. Background: The therapeutic progress for adults with acute lymphoblastic leukemia (ALL) has been slow, with a 5‐year survival of 30% to 45% in developed countries. Scarce information is available regarding the treatment and survival rates from nonindustrialized populations. In the present study, the characteristics of adults with ALL at a single institution were documented. Patients and Methods: The clinical files of patients aged ≥ 18 years who had been diagnosed with ALL from 2005 to 2015 at a reference center in Mexico were scrutinized. Overall survival (OS) and event‐free survival (EFS) were determined using the Kaplan‐Meier method. The hazard ratios for death and relapse were estimated using Cox regression analysis. Results: A total of 94 adults were included. Their median age was 33 years; 69 (73.4%) had high‐risk and 25 (26.6%) had standard‐risk ALL. Of the 94 patients, 67 (71.3%) achieved complete remission (CR), 20 (21.3%) experienced disease resistance, and 7 (7.4%) died early during induction to remission, mainly of sepsis. The 5‐year EFS and OS was 23.4% and 31.1% for the whole group and 24.9% and 38.9% for patients who achieved CR, respectively. Of the 94 patients, 50 (43.9%) died of sepsis or disease progression. Relapse developed in 43 patients (45.7%). The median survival after relapse was 6.93 months. Bone marrow was the most frequent site of relapse (21 patients [48.8%]) and conferred a significantly lower 5‐year OS of 16.4%. Conclusion: Adults with ALL in Mexico had high‐risk characteristics and an increased relapse rate; however, the OS after CR was similar to the greatest achieved in developed countries, suggesting that a threshold for curing adult ALL with current therapeutic strategies has been reached.

Use of complementary and alternative medicine by patients with hematological diseases experience at a university hospital in northeast Mexico

Background Complementary and alternative medicine includes a diverse group of medical and healthcare systems, practices and products not considered part of conventional medicine. Although there is information on unconventional practices in oncological diseases, specific data regarding the use of complementary and alternative medicine by hematology patients is scarce. Objective The aim of this study is to document the prevalence of this modality of unconventional therapy in patients with malignant and benign hematological diseases, particularly children with acute lymphoblastic leukemia. Methods An observational study of adult patients and guardians of children with malignant or benign hematological diseases was carried out by applying a structured questionnaire detailing the use and results of the most prevalent complementary and alternative medicine practices. Results One hundred and twenty patients were included; 104 had malignant and 16 had benign hematological diseases. The use of complementary and alternative medicine was greater in benign diseases but the difference was not statistically significant (64.7% versus 41.7%; p-value = 0.08). Patients and guardians with high school or college educations used these alternative practices more than patients with less schooling (60.7% versus 54.7%; p-value = 0.032). The use of folk remedies was most prevalent followed by herbal preparations and spiritual healing. Sixty-four percent of patients that used these unconventional practices reported improvement in their symptoms and increased capacity to perform daily activities. Conclusion No significant difference was documented between patients with malignant or benign hematological diseases using these alternative practices. The majority of complementary and alternative medicine users reported improvement of the disease or chemotherapy-related symptoms.

Long-Term Remission and Bone Marrow Findings in Children with Severe Aplastic Anemia Immunosuppressed with High Doses ofCyclophosphamide

Background: Most cases of aplastic anemia are acquired and of autoimmune etiology. Treatment of patients lacking a stem cell donor habitually consists of two curses of immunosuppression with anti-thymocyte globuline plus cyclosporine (ATG/CSA), whereas intensive immunosuppression consisting exclusively of high doses of cyclophosphamide (HDCY) has been successfully employed mostly in adults, detailed long-term information on children receiving HDCY is lacking. Patients and methods: Five children suffering from severe acquired aplastic anemia and without an HLAcompatible stem cell donor were immunosuppressed with high-dose cyclophosphamide (HDCY) at a total dose of 200 mg/kg over four days. Granulocyte colony-stimulating factor (G-CSF) was administered at 5 μg/kg/day until sustained neutrophil and platelet count recovery. The surviving patients were followed-up for twelve years and their bone marrows examined at this time. Results:Three of the five children obtained a complete sustained hematological remission. Current ages are 17, 19 and 27. After twelve years of follow-up two patients have normal hematological values, with no relapse nor clonal or displasic hematological disorders, their bone marrow aspirate was morphologically normal, whereas bone marrow trephine biopsy histopathology demonstrated a reduced cell content to about 60% of normal. One patient developed myelodisplasia 12 years after HDCY and currently he is being considered for a bone marrow transplant. Conclusions: Sustained long-term trilineage hematopoiesis can be rescued in children suffering from SAA employing HDCY as the only immunosuppressor; the bone marrow did not fully recuperate its normal cellularity after twelve years post-treatment, mielodysplasia can develop more than ten years after HDCY.

Revisiting the complete blood count and clinical findings at diagnosis of childhood acute lymphoblastic leukemia: 10-year experience at a single center

Background Heterogeneity regarding clinical and laboratory findings at diagnosis of acute lymphoblastic leukemia exists. The frequency of complete blood count abnormalities and its combinations, symptoms and physical findings were investigated in Hispanic children from an open population at the diagnosis of acute lymphoblastic leukemia. Methods The patient charts and electronic records of under 16-year-old children diagnosed with acute lymphoblastic leukemia over 10 years at a regional hematology center of a university hospital were analyzed to retrieve data concerning the complete blood count at first evaluation. Type and distribution of abnormal data, frequency of symptoms and physical findings at presentation were documented. Results The records of 203 children aged 0–15 years diagnosed with acute lymphoblastic leukemia from 2006 to 2016 were revisited. The results of the blood workup showed a median white blood cell count of 7120 × 109/L (range: 450–600,000 × 109/L), and a median hemoglobin concentration of 7.5 g/dL (range: 2.4–15.3 g/dL), whereas the median platelet count was 47,400 × 109/L (range: 4000–544,000 × 109/L). Leukocytosis and leukopenia were present in 36.6% and 36.1% of cases, respectively; anemia was diagnosed in 82.9% children. The order of frequency for major clinical symptoms was fatigue 62%, fever 60%, bone and joint pain 39%, hyporexia 33% and weight loss 21%, while main physical findings were hepatomegaly 78%, splenomegaly 63%, lymphadenopathy 57%, pallor 48%, and purpura 30%. Conclusion Data differing from those classically expected at diagnosis of acute lymphoblastic leukemia in children were documented in a cohort of Hispanic children over one decade with a wide spectrum of complete blood count abnormalities, forms of presentation and frequency of physical findings.

Contributions of a regional approach to document hematologic disease in Mexico: a 10-year experience in an open population

ABSTRACT Objectives: To demonstrate the importance of regional efforts to register features and report frequency of hematology diseases in the context of incomplete national registries. Methods: Frequencies and salient characteristics of hematologic diseases in Northeast Mexico were documented in a reference center at a tertiary care university hospital during the decade 2005–2015. Disease categories were grouped by age, sex and diagnosis. Age group distribution followed WHO guidelines in years as children (0–17), adults (18–64) and elders (+65). Results: 2406 patients were included: 1239 (51.5%) were females and 1167 (48.5%) males; F:M ratio was 1.06:1; median age was 35 years (0–95). The frequency by age group included adults, 1370 cases (56.9%), children, 695 cases (28.9%), and elderly, 341 (14.2%). Most frequent diagnoses were acute lymphoblastic leukemia (ALL) 18.2% (n = 438), anemia 15.9% (n = 383), non-Hodgkin’s lymphoma (NHL) 15.7% (n = 378), immune thrombocytopenic purpura (ITP) 9.8% (n = 235) and Hodgkin’s lymphoma (HL) 6.5% (n = 156). Median age for the whole cohort was 35 years; for children, was 6 years, for adults 40 and for the elderly 73. Results for ALL, anemia and ITP were comparable to high-income countries; NHL, HL and chronic myeloid leukemia presented a decade earlier. Discussion: Complete, opportune reliable information on the number of cases, age and sex distribution with the potential to influence strategies for timely diagnosis and treatment options for important hematologic diseases can be accrued by regional centers. Conclusion: Information on hematology diseases derived of regional registries in low-middle income countries is a reasonable alternative to complement and update national registries.