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1.
J Adolesc Young Adult Oncol ; 13(2): 323-330, 2024 Apr.
Article de Anglais | MEDLINE | ID: mdl-37843922

RÉSUMÉ

Purpose: Patients with diffuse large B-cell lymphoma (DLBCL) are typically treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). However, a standard of care for managing adolescents and young adults (AYAs) with DLBCL is lacking. We examine treatment approaches and outcomes of this population. Methods: We included 90 AYAs (15-39 years) diagnosed with DLBCL between 2008 and 2018 in three tertiary centers in Peru. Overall response rates (ORR) were available for all patients. Overall survival (OS) and progression-free survival (PFS) rates were estimated using the Kaplan-Meier method. Results: The median age at diagnosis was 33 years, 57% were males, 57% had good performance status (Lansky/Karnofsky ≥90), and 61% were diagnosed with early-stage disease (Ann Arbor stages I-II). R-CHOP (n = 69, 77%) was the most frequently used first-line regimen, with an ORR of 91%. With a median follow-up of 83 months, the 5-year OS and PFS among all patients were 79% and 67%, respectively. Among the patients who received R-CHOP, the 5-year OS and PFS were 77% and 66%, respectively. Of the 29 (32%) patients with relapsed/refractory (R/R) disease, 83% received second-line treatment and only 14% underwent consolidation therapy with autologous transplantation. The 3-year OS for R/R DLBCL was 36%. Conclusion: Our data show that AYAs with DLBCL who received conventional therapy had comparable outcomes to those observed in studies conducted among the adult population. However, the prognosis for AYAs with R/R disease was dismal, indicating the unmet need for developing and increasing access to novel treatment modalities in AYAs.


Sujet(s)
Protocoles de polychimiothérapie antinéoplasique , Lymphome B diffus à grandes cellules , Mâle , Humains , Jeune adulte , Adolescent , Adulte , Femelle , Études rétrospectives , Protocoles de polychimiothérapie antinéoplasique/usage thérapeutique , Rituximab/usage thérapeutique , Pronostic , Lymphome B diffus à grandes cellules/traitement médicamenteux
2.
Pediatr Blood Cancer ; 68(4): e28908, 2021 04.
Article de Anglais | MEDLINE | ID: mdl-33501779

RÉSUMÉ

BACKGROUND: Diagnosis delay in children and adolescents with cancer is a public health problem in Peru that leads to high rates of advanced disease and mortality. We aimed to assess the implementation feasibility and potential utility of ONCOpeds®, a mobile application that provides consultations with pediatric oncologists, in reducing the latency to diagnosis (LD) and referral time (RT) among children and adolescents in Peru diagnosed with cancer. MATERIAL AND METHODS: A prospective pilot study was conducted in the region of Callao between November 2017 and April 2018. Primary and secondary care providers were trained on the use of ONCOpeds in five educational sessions. Patients younger than 18 years who resided in Callao and were diagnosed with cancer at four pediatric cancer units in Lima were analyzed by referral type: ONCOpeds facilitated or conventional. RESULTS: ONCOpeds was successfully installed in the smartphones of 78 primary and secondary care providers of Callao. During the study period, 23 new cases of cancer in children and adolescents from the region were diagnosed. Ten patients received ONCOpeds-facilitated referrals and 13 received conventional referrals. The RT decreased among those who received ONCOpeds-facilitated referrals by 66% (P = 0.02); however, the LD did not significantly decrease with the use of ONCOpeds. CONCLUSIONS: The implementation of ONCOpeds was found to be feasible in this pilot study, having a potential utility in improving early diagnosis and referral in children and adolescents newly diagnosed with cancer. Directions for future research include multicenter studies with a larger population to further test the application's effectiveness.


Sujet(s)
Dépistage précoce du cancer/méthodes , Applications mobiles , Tumeurs/diagnostic , Adolescent , Enfant , Enfant d'âge préscolaire , Femelle , Humains , Revenu , Nourrisson , Mâle , Tumeurs/épidémiologie , Pérou/épidémiologie , Projets pilotes , Études prospectives
4.
J Pediatr Hematol Oncol ; 39(7): 538-546, 2017 10.
Article de Anglais | MEDLINE | ID: mdl-28697168

RÉSUMÉ

BACKGROUND: Pretreatment neutrophil-to-lymphocyte ratio (NLR) and absolute lymphocyte count (ALC) recovery have been shown to be associated with prognosis in several types of cancer in adults. However, evidence in pediatric cancer is scarce. The aim of our study was to evaluate whether pretreatment NLR and lymphocyte recovery are prognostic factors in pediatric sarcomas. MATERIALS AND METHODS: Study participants were identified from a retrospective cohort of 100 children with osteosarcoma (n=55), rhabdomyosarcoma (n=22), and Ewing sarcoma (n=23). Data for the hematological variables were obtained from medical records and analyzed with other known prognostic factors in univariate and multivariate analyses. RESULTS: In multivariate analysis, NLR>2 was an independent prognostic factor for OS in patients with osteosarcoma (hazard ratio [HR], 2.27, 95% confidence interval [CI], 1.07-5.30; P=0.046) along with metastatic disease and poor histologic response; as well as in patients with rhabdomyosarcoma (HR, 4.76, 95% CI, 1.01-22.24; P=0.0237) along with metastatic disease and risk group. ALC recovery correlated for inferior OS in osteosarcoma (HR, 3.34, 95% CI, 1.37-8.12; P=0.008) and rhabdomyosarcoma (HR, 3.89; 95% CI, 1.01-14.89; P=0.0338). CONCLUSIONS: Our study confirms that NLR and ALC recovery are independent prognostic factors for pediatric sarcomas, implying an important role of immune system in survival. Clinical utility of these prognostic biomarkers should be validated in larger pediatric studies.


Sujet(s)
Lymphocytes/anatomopathologie , Granulocytes neutrophiles/anatomopathologie , Pronostic , Sarcomes/diagnostic , Marqueurs biologiques , Enfant , Études de cohortes , Femelle , Humains , Numération des leucocytes , Mâle , Métastase tumorale , Ostéosarcome/traitement médicamenteux , Ostéosarcome/mortalité , Études rétrospectives , Rhabdomyosarcome/traitement médicamenteux , Rhabdomyosarcome/mortalité , Sarcomes/sang , Sarcomes/mortalité , Sarcomes/anatomopathologie , Sarcome d'Ewing/traitement médicamenteux , Sarcome d'Ewing/mortalité , Taux de survie
5.
Support Care Cancer ; 24(1): 253-259, 2016 Jan.
Article de Anglais | MEDLINE | ID: mdl-26014616

RÉSUMÉ

PURPOSE: The purpose of this study is to evaluate the impact of fecal extended-spectrum ß-lactamase-producing Escherichia coli (ESBL-EC) colonization for bloodstream infection (BSI), clinical outcome, and costs in patients with hematologic malignancies (HM) and severe neutropenia. METHODS: This is a cohort study, carried out at a cancer-referral hospital. The study population comprises patients with HM, hospitalized prior to administration of the first chemotherapy cycle. A stool culture was taken during the first 48 h; they were grouped as colonized by ESBL-EC or non-ESBL-EC. Patients were followed upon completion of chemotherapy or death. The sum of the days of antibiotics and the length of stay of all hospitalizations in the different cycles of chemotherapy were recorded. RESULTS: We included 126 patients with a recent diagnosis of HM, grouped as 63 patients colonized by ESBL-EC and 63 colonized by non-ESBL-EC, aged 42 ± 16 years old, 78 males (62%). BSI by ESBL-EC developed in 14 patients (22.2%) colonized by the same strain and in 5 (7.9%) in the group colonized with non-ESBL-EC. BSI by non-ESBL-EC was observed in 3 patients (4.7%) colonized by ESBL-EC and in 17 (26.9%) patients colonized by non-ESBL-EC. Colonization with ESBL-EC increased the risk of BSI by the same strain (relative risk (RR) = 3.4, 95% confidence interval (95% CI) 1.5-7.8, p = 0.001), shorter time to death (74 ± 62 vs. 95 ± 83 days, p < 0.001), longer hospital stay (64 ± 39 vs. 48 ± 32 days, p = 0.01), and higher infection-related costs ($6528 ± $4348 vs. $4722 ± $3173, p = 0.01). There was no difference in overall mortality between both groups. CONCLUSIONS: Fecal colonization by ESBL-EC is associated with increased risk of BSI by this strain, longer hospital stay, and higher related costs.


Sujet(s)
Bactériémie/étiologie , Infections à Escherichia coli/étiologie , Fèces/microbiologie , Tumeurs hématologiques/complications , Adulte , Bactériémie/microbiologie , Études de cohortes , Infections à Escherichia coli/mortalité , Femelle , Tumeurs hématologiques/traitement médicamenteux , Humains , Mâle , Études prospectives , Facteurs de risque
6.
Health Policy Plan ; 31(4): 444-53, 2016 May.
Article de Anglais | MEDLINE | ID: mdl-26329891

RÉSUMÉ

This article examines the role of components of adequate antenatal care (ANC) in disparities in birth weight between indigenous and non-indigenous women in Mexico. We estimate the potential for added weight gain among indigenous infants if their mothers received timely, frequent ( ≥4 visits) and complete ANC (≥75% of recommended processes of care). We used population-based survey data (2012;N= 6612 women 12-49). We applied quantile regression to examine heterogeneity of the association between adequate ANC, indigenous ethnicity and birth weight across quantiles of the birth weight distribution. A greater proportion of indigenous women reported a low-birth weight infant (<2.5 kg) at last delivery (14 vs 8% among non-indigenous women). Coverage of adequate ANC (timely, frequent and complete care) is lower among indigenous (59%, CI:53;65) than non-indigenous (68%, CI:66;70) women. Indigenous ethnicity is associated with a lower birth weight across quantiles of the observed birth weight distribution: between 300 g in the 0.05, 0.10 and 0.25 quantiles. Among indigenous women, greater newborn weight gains are achieved in the lowest quantiles if they have access to ≥75% of the content of ANC compared with those that did not have access: ∼180 and 260 g are gained in both quantiles 0.05 and 0.10, respectively. This means that the smallest indigenous newborns could potentially reach 2.36 kg (from 1.86 kg), close to the normal weight threshold. The frequency of ANC was positively associated with birth weight for all women but complete ANC appears to differentially affect indigenous women at the bottom of the birth weight distribution. The marginal gains obtained among indigenous newborns that received complete ANC compared with indigenous/non-indigenous newborns did not receive it, is particularly important in low-birth weight quantiles. Delivering basic processes of ANC may therefore have the potential to impact the highest risk women and help them to overcome the low-birth weight threshold.


Sujet(s)
Poids de naissance , Disparités de l'état de santé , Prise en charge prénatale/méthodes , Adolescent , Adulte , Enfant , Femelle , Humains , Nourrisson à faible poids de naissance , Nouveau-né , Mexique , Adulte d'âge moyen , Groupes de population/statistiques et données numériques , Grossesse , Prise en charge prénatale/normes , Prise en charge prénatale/statistiques et données numériques , Jeune adulte
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