• Asociación entre la desnutrición y la sobrevida libre de evento a 5 años en niños y adolescentes entre 0 y 14 años con Leucemia Linfática Aguda, diagnosticados entre el año 2005 y 2010 en el Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima - Perú

      Alvarado Cutipa-Flores, German F.; García León, Juan Luis; Martínez Novack, María Claudia; Ortiz Ortiz, María Teresa Beatriz; Castañeda Carbajal, Bruno Enrique (Universidad Peruana de Ciencias Aplicadas (UPC), 21/02/2017)
      Objective: To determine the association between overall survival and nutritional status at diagnosis of patients with Acute Lymphoblastic Leukemia (ALL). Materials and Methods: We included 722 children between 0 and 14 years diagnosed with ALL at Instituto Nacional de Enfermedades Neoplásicas (INEN) from Peru between 2005 and 2010. The outcome was overall survival. The covariate measured were age, sex, type of leukemia, risk stratification, blasts in bone marrow and peripheral blood, and nutritional status at diagnosis. A Cox regression analysis was performed from where the Hazard Ratio (HR) was derived with 95% CI. Results: 56.7% of the patients were male, 7.1% presented malnutrition and 25.9% died. Malnourished patients had a 1.8-fold higher hazard of mortality (p = 0.02), compared with patients who were not malnourished, adjusted with the rest of the model variables. Discussion: We conclude that there is an association between nutritional status (malnutrition) at diagnosis and mortality in ALL. More studies are needed especially in developing countries.
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    • Leucemia Linfática Aguda en niños con Síndrome de Down: Sobrevida en un hospital de Lima, Perú

      Pereyra Elías, Reneé; Mayta-Tristan, Percy; Alvarez-Manassero, Denisse (Universidad Peruana de Ciencias Aplicadas (UPC), 2017-07-13)
      Background: Down Syndrome (DS) is the most common chromosomal abnormality in humans. Acute Lymphocytic Leukemia (ALL) is the leading cause of cancer in the pediatric population. In children with DS, the risk of developing ALL is increased up to 40 times fold compared to pediatric population. In Peru, children with DS and ALL are treated using the standard Berlin-Frankfurt-Münster protocol (BFM) for patients without DS. We did not identify any published investigation about the therapeutic approach or survival in patients with DS and ALL. Objective: To describe the Disease Free Survival (DFS) and Overall Survival (OS) rates in pediatric patients with DS and ALL diagnosed and treated at the Pediatric Hematology Unit of the Department of Hematology at the Edgardo Rebagliati Martins National Hospital (HNERM) between 1999 and 2016. Methods: The study design is a retrospective cohort type, constructed with data from the registry system of the Pediatric Hematology Unit of the HNERM, a high complexity hospital located in Lima, Peru. We studied 57 pediatric patients with DS and ALL treated using the standard BFM protocol from 1999 to 2016, according to the associated risk stratification. Results: Five-year survival was 36.7% and 44.9%, respectively, with disease-free survival (DFS) and overall survival (OS). High and very high risks were classified as 61.4% and 28.1% respectively. 100% of patients achieved complete post-induction remission. The relapse rate was 12.2 per 1000 person / month follow-up (95% CI: 8.0 to 15.7). Although the overall survival of males was lower than in females, this difference was not statistically significant (p = 0.142). No association with other variables was found. Conclusion: Patients with DS and ALL treated in a high complex hospital in Lima, Peru from 1999 to 2016 using the standard BFM protocol, showed lower index for DFS and OG than those reported internationally. Further research is needed in order to identify associated variables with the indicators evaluated.
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