Neutropenia febril de alto riesgo en leucemia aguda. Experiencia en un hospital público. Programa Nacional de Drogas Antineoplásicas del Adulto (PANDA), Hospital del Salvador, 1991-2001 / High risk febrile neutropenia in acute leukemia. The experience of a public hospital. National Program of Antineoplastic Drugs in Adult, Hospital del Salvador, 1991-2001

BACKGROUND: Febrile neutropenia is one of the most important problems to face during the treatment of acute leukemia. AIM: To assess the results of a standardized protocol for the treatment of febrile neutropenia and compare it with a period in which treatment was not standardized. PATIENTS AND METHODS: One hundred and eight episodes of febrile neutropenia in 69 patients, treated with a standardized antimicrobial protocol between 1996 and 2001, were analyzed. The protocol consisted in the use of a combination of antimicrobial whose spectrum was broadened progressively according to the isolated microorganisms and the involved foci. These were compared with 83 episodes in 54 patients, treated without standardized protocols between 1990 and 1995. RESULTS: Both groups of patients were comparable. Their ages ranged from 15 to 65 years old. The male/female ratio was 1.3 and the lymphoblastic/myeloid leukemia ratio was 1.4. Sixty one percent of episodes occurred during induction chemotherapy and mean duration of neutropenia was 17 days. A clinically significant focus was identified in 72 per cent of episodes and a microorganism was isolated blood culture in 35 per cent of them. There was a predominance of gram negative organisms. The mortality decreased from 18 to 9 per cent in the period 1996-2000 (p = 0.094). CONCLUSIONS: The use of a standardized antimicrobial protocol reduced the mortality in febrile neutropenia, even when colony stimulating factors and filtered air rooms are unavailable.

[Clinical significance and frequency of the 11q23/MLL genetic molecular alteration in Chilean infants with acute leukemia]. / Significado clínico y frecuencia de la alteración genético/molecular 11q23/MLL en lactantes con leucemia aguda en Chile.

BACKGROUND: Acute leukemia (AL) in infants generally shows distinctive biologic features and has a poor prognosis. AIM: To study the frequency of the cytogenetic alteration of 11q23 chromosome or the recombination of MLL gene in infants less than 18 months old, with acute leukemia. PATIENTS AND METHODS: We analyzed 37 cases of AL in infants less than 18 months of age diagnosed in Chile from 1989 to 1999. The clinical features and cytogenetic/molecular defects of 11q23MLL gene rearrangement and their influence in prognosis were determined. RESULTS: There were 18 cases of acute Lymphoblastic leukemia (ALL) characterized by female sex (67%) high presenting leukocyte count (median 99 x 109/L), blast cells with a CD10 negative phenotype (50%) and 11q23/MLL rearrangement (39%). Molecular abnormalities of 11q23 were significantly associated with adverse prognosis, with an event free survival (EFS) of only 14 +/- 12%. Interestingly, infants with germ line 11q23 had a very good outcome with an EFS of 73 +/- 11% (p < 0.025). There were 19 cases of acute myeloblastic leukemia (AML) characterized by male sex (63%) high leukocyte count (median 93 x 109/L), FAB-MS morphology (53%) and 11q23/MLL rearrangement (53%). EFS was very poor, 20 +/- 9% and 33 +/- 4% for rearranged and germinal group respectively (p = NS), due to a high mortality rate during the first month of diagnosis. CONCLUSIONS: These findings demonstrate that Chilean ALL infants with 11q23 abnormalities have a very poor prognosis. However those with germinal state can enjoy a prolonged disease free survival with the current treatment protocols.

[Acute myeloid leukemia in the adult. Results of the National Antineoplastic Drug Protocol at the Hospital del Salvador, 1990-1998]. / Leucemia mieloide aguda del adulto. Resultados del Protocolo Nacional de Drogas Antineoplásica. Hospital del Salvador 1990-1998.

BACKGROUND: The incidence of acute myeloid leukemia is 3 cases per 100,000 inhabitants/year and its five years event free survival is 15 to 20%. Since the incorporation of trans retinoic acid, event free survival of M3 acute myeloid leukemia is 80%. AIM: To report the results of acute myeloid leukemia treatment at the Hospital del Salvador, between 1990 and 1998. PATIENTS AND METHODS: The medical records of 117 patients (66 female, mean age 48.2 years), treated between 1990 and 1998 using PANDA protocol, were retrospectively reviewed. Immunophenotyping was done in 69 patients and cytogenetic studies were done in 65. RESULTS: Sixteen percent of patients had M3 acute myeloid leukemia. The most frequent phenotype was the association of DR, CD34 plus a panmyeloid marker. DR and CD34 were negative in seven of nine patients with M3 acute myeloid leukemia. Cariotype was abnormal in 78% of patients. Complete remission was achieved in 65% of cases with a 13% of failures. Early mortality was 21.3% and decreased to 6.1% in the last three years. Infections and coagulation disorders were the main causes of death. Mean survival was 10.5 months. Five years event free survival was 11%. In M3 acute myeloid leukemia, the figure is 50%. CONCLUSIONS: Treatment results are less effective than protocols that consider more aggressive chemotherapeutic protocols or bone marrow transplantation. The reduction in early mortality is due to a better management of febrile neutropenia.

[Results of the National Protocol for Antineoplastic Drugs in the treatment of adult acute lymphoblastic leukemia. Experience at the Hospital del Salvador, 1990-1997]. / Resultados del Protocolo Nacional de Drogas Antineoplásicas para el tratamiento de la leucemia linfoblástica aguda del adulto. Experiencia en el Hospital del Salvador, 1990-1997.

BACKGROUND: Acute lymphoblastic leukemia has a different evolution in children and adults. Complete remission is achieved in 70-85% of the latter, but only 25 to 35% have a prolonged disease-free survival. AIM: To assess the treatment outcome of adults with acute lymphoblastic leukemia in Chile. PATIENTS AND METHODS: A retrospective review of the medical files of 51 adults with acute lymphoblastic leukemia treated according to the national protocol for antineoplastic drugs, in a public hospital of Santiago. RESULTS: Mean age of patients was 35.9 years old and 53% were younger than 20 years old. Complete remission was achieved in 64%. Early mortality occurred in 22%, mostly due to infections. Treatment failure occurred in 16%. Global survival was 17 months and global survival at 5 years was 24%. Prognostic criteria of the protocol, defined a low risk group that had a complete remission of 100%, no early deaths and 5 year disease-free survival of 53%. The group defined as having high risk had a complete remission of 47%, a 29% early mortality and a 5 years disease-free survival of 6%. CONCLUSIONS: Aiming to improve treatment results in acute lymphoblastic leukemia, efforts should be made to improve the management of febrile neutropenic patients and to intensify chemotherapy.