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Introducción. Actualmente las antraciclinas se han incorporado en más de 50% de los protocolos de tratamiento para cáncer en la población infantil. La utilidad clínica de estos agentes queda limitada por la aparición de cardiomiopatías, cuya presencia depende de la dosis total del fármaco y suele ser irreversible. El ecocardiograma es el estudio más utilizado para la detección de cardiotoxicidad por antraciclinas. El objetivo de este trabajo fue describir la evolución de los índices de funcionamiento cardiaco reportados por ecografía durante el tratamiento de niños con cáncer con esquemas que contenían antraciclinas. Métodos. Se incluyeron pacientes pediátricos con diagnóstico de osteosarcoma y leucemia mieloide aguda tratados entre enero del 2006 y mayo del 2011 en el Hospital Infantil de México Federico Gómez. En el expediente clínico se documentaron los valores de las fracciones de eyección y acortamiento reportadas antes de cada ciclo. Se utilizó estadística descriptiva para el reporte de los resultados. Resultados. La fracción de eyección prácticamente no sufrió variaciones hasta el sexto ciclo de tratamiento a una dosis acumulada de 332.5 mg/m²SC, para posteriormente decaer de forma acelerada. En la fracción de acortamiento el mayor cambio se produjo después del séptimo ciclo, a una dosis acumulada de 450 mg/m²SC. Conclusiones. Reconocer el daño que se produce en etapas tempranas es un paso fundamental en la prevención de complicaciones. El reto es implementar nuevas herramientas que nos permitan alcanzar el objetivo de prevención o de diagnóstico de enfermedad subclínica.
Background. Currently, anthracyclines have been used in >50% of cancer treatment protocols in children. The clinical usefulness of these agents is limited by the onset of cardiomyopathy whose presence depends on the total dose of drug and usually is irreversible. Echocardiography is used to study anthracycline cardiotoxicity detection. The aim of this study was to describe the evolution of cardiac function reported by echocardiography for treatment of children with cancer whose medications contain anthracyclines. Methods. We included pediatric patients diagnosed with osteosarcoma and acute myeloid leukemia treated between January 2006 and May 2011 in the Hospital Infantil de México Federico Gómez. In the clinical files, values were documented for ejection fraction and shortening reported before each cycle, using descriptive statistics for reporting results. Results. The ejection fraction experiences virtually no changes until the 6th cycle of treatment to a cumulative dose of 332.5 mg/m²/sc, afterwards it demonstrates an accelerated decline. According to the shortening fraction, the most significant change occurs after the seventh cycle to a cumulative dose of 450 mg/m²/sc. Conclusions. Recognizing the damage that occurs during the early stages is a critical step in preventing complications. The challenge is to implement new tools that will allow us to achieve the objective of preventing or diagnosing subclinical disease.
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BACKGROUND: Interleukin-1 receptor antagonist polymorphism (ILRN) 2 (ILRN*2) has been associated with a poor outcome in septic patients because of an elevated production of anti-inflammatory cytokines. In >70% of patients, morbidity and mortality in childhood acute lymphoblastic leukemia is caused by infections. The aim of this study was to determine the association between this polymorphism and the frequency of septic shock from the time of diagnosis until completion of treatment. METHODS: This cohort study was conducted in 57 consecutive children with acute lymphoblastic leukemia. At the end of follow-up, children were stratified according to their IL1RN polymorphism (ILRN*1/ILRN*2), evaluating the impact of genotype on the severity of febrile neutropenic events during their treatment. RESULTS: Overall survival was 80% at 55 months after treatment. The average number of febrile neutropenic events in this cohort was 2.82 per patient. Genotype distribution was 50.9% for homozygote IL-1RN*1, 38.6% for heterozygote ILRN*1/ILRN*2 and 10.5% for homozygote IL-1RN*2. The risk of presenting septic shock for homozygote IL1RN*2/IL1RN*2 and heterozygote ILRN*1/ILRN*2 patients was significantly greater (odds ratio, 45; P = 0.001) adjusted for age, gender, risk of leukemia and presence of pathogenic bacteria. Genotype IL-1RN*2 is associated with the risk of development of septic shock in children with acute lymphoblastic leukemia. Further research in larger population-based studies is needed to replicate these findings. CONCLUSIONS: This information would allow us to identify more predictive factors in this group of acute lymphoblastic leukemia patients in whom this information is lacking to establish an earlier and more aggressive approach.
Assuntos
Proteína Antagonista do Receptor de Interleucina 1/genética , Leucemia-Linfoma Linfoblástico de Células Precursoras/genética , Choque Séptico/genética , Adolescente , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Feminino , Febre/genética , Febre/imunologia , Seguimentos , Predisposição Genética para Doença , Genótipo , Humanos , Lactente , Proteína Antagonista do Receptor de Interleucina 1/imunologia , Modelos Logísticos , Masculino , Neutropenia/genética , Neutropenia/imunologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/imunologia , Choque Séptico/imunologia , Estatísticas não ParamétricasRESUMO
Introducción. La secuencia de Pierre-Robin (SPR) es una afección congénita caracterizada por micrognatia, glosoptosis y fsura del paladar blando. La prevalencia es 1:8500 recién nacidos (RN) vivos. El hepatoblastoma (HB) es el tumor maligno primario de hígado más frecuente en pediatría. Afecta niños menores de 3 años. Caso clínico. Se trata de un paciente masculino de 2 años de edad, producto de la gesta II, de término, obtenido por cesárea, peso al nacer de 2, 750 g, con diagnóstico de SPR. A los 2 años se detecta masa abdominal dependiente de hígado. Se diagnostica HB, por lo que requiere quimioterapia y cirugía (lobectomía izquierda). A 5 años de seguimiento está vivo sin actividad tumoral. Conclusiones. La asociación de SPR y HB no se encontró reportada previamente en la literatura. Ambas presentan alteraciones en el cromosoma 2. Dado que el cáncer cursa con alteraciones citogenéticas, debemos de establecer asociaciones entre aquellos pacientes que cursan con síndromes genéticos. Esto permite evaluar blancos moleculares útiles y diseñar terapias dirigidas. También permite detectar poblaciones de riesgo de padecer cáncer y crear programas de seguimiento y evaluación que permitan una detección temprana para mejorar la sobrevida de dichos grupos. Se trata del primer caso de asociación entre estas dos patologías reportado en nuestro instituto y en el mundo.
Background. Pierre-Robin Sequence (PRS) is a congenital disease characterized by micrognatia, glosoptosis and U-shaped posterior cleft palate. Its prevalence is 1:8500 newborns. Hepatoblastoma (HB) is the most frequent hepatic malignant tumor in childhood and affects patients <3 years of age. Case report. A 2-year old male with PRS was diagnosed with HB. The boy was the product of the second full term pregnancy. He was born by cesarean with a birth weight of 2750 g. The patient presented with a 1-month history of abdominal mass. Diagnosis of HB was done by biopsy. The patient received chemotherapy with cisplatin, vincristin and 5-fuorouracil as well as left lobectomy. Five years later he is alive without tumor activity. Conclusions. PRS and HB association has not been reported in the literature. Both entities have chromosome 2 alterations. Because cancer is associated with cytogenetic alterations, future considerations must be made to fnd a relationship between cancer patients and other genetic entities. This will be useful for fnding molecular targets. We can also detect the at-risk population in order to create follow-up programs that will allow an early diagnosis with an improved better survival. It is the frst case of PRS and HB reported in either the national or international literature.
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Introducción. Con los tratamientos disponibles en la actualidad, más de 80% de los niños con leucemia aguda linfoblástica (LAL) pueden sobrevivir. En general, y especÃficamente en nuestra institución, no se conoce bien la calidad de vida (CV) de estos niños. El objetivo de este estudio fue medir la CV en niños durante la inducción a la remisión (primera fase del tratamiento) con el PedsQL Cancer Module©. Métodos. Se realizaron 2 mediciones a niños con LAL de diagnóstico reciente. Se incluyeron 26 pacientes estables de 2 a 18 años de edad con LAL, a las 2 semanas y a los 2 meses del diagnóstico. Se dividieron en 4 grupos: 2-4, 5-7, 8-12 y 13-18 años. Resultados. Se determinó que la CV se modificó al finalizar la inducción a la remisión. En la segunda medición se observó mejor CV con relación a un proceso de posible adaptación al tratamiento, así como por mejoría de los síntomas relacionados a la enfermedad. Conclusión. El PedsQL Cancer Module© fue útil para medir la CV y detectar cambios en los niños con LAL en inducción a la remisión.
Introduction. Survival of children with acute lymphoblastic leukemia (ALL) is 80% in accordance with actual protocols. We ignore quality of life (QoL) during these chronic treatments, especially in our institution. The aim of this pilot study was to measure QoL in stable children with ALL during the first part of treatment (induction therapy) with PedsQL Cancer Module©. Methods. We made two measurements in children with recent diagnosis of ALL and determined changes in the QoL between the beginning and the end of induction therapy. We included 26 patients from 2 to 18 years of age with ALL, at 2 weeks and 2 months after diagnosis, and divided them into four groups: 2-4, 5-7, 8-12, and 13-18 years of age. Results. In the second measurement, we observed a better QoL in relation to an adaptation process in the child and remission of symptoms. Conclusions. PedsQL Cancer Module© was a useful instrument for measuring QoL and detected changes in children with ALL during induction therapy.
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BACKGROUND: Medical research has not been able to establish whether a father's occupational exposures are associated with the development of acute leukemia (AL) in their offspring. The studies conducted have weaknesses that have generated a misclassification of such exposure. Occupations and exposures to substances associated with childhood cancer are not very frequently encountered in the general population; thus, the reported risks are both inconsistent and inaccurate. In this study, to assess exposure we used a new method, an exposure index, which took into consideration the industrial branch, specific position, use of protective equipment, substances at work, degree of contact with such substances, and time of exposure. This index allowed us to obtain a grade, which permitted the identification of individuals according to their level of exposure to known or potentially carcinogenic agents that are not necessarily specifically identified as risk factors for leukemia. The aim of this study was to determine the association between a father's occupational exposure to carcinogenic agents and the presence of AL in their offspring. METHODS: From 1999 to 2000, a case-control study was performed with 193 children who reside in Mexico City and had been diagnosed with AL. The initial sample-size calculation was 150 children per group, assessed with an expected odds ratio (OR) of three and a minimum exposure frequency of 15.8%. These children were matched by age, sex, and institution with 193 pediatric surgical patients at secondary-care hospitals. A questionnaire was used to determine each child's background and the characteristics of the father's occupation(s). In order to determine the level of exposure to carcinogenic agents, a previously validated exposure index (occupational exposure index, OEI) was used. The consistency and validity of the index were assessed by a questionnaire comparison, the sensory recognition of the work area, and an expert's opinion. RESULTS: The adjusted ORs and 95% confidence intervals (CI) were 1.69 (0.98, 2.92) during the preconception period; 1.98 (1.13, 3.45) during the index pregnancy; 2.11 (1.17, 3.78) during breastfeeding period; 2.17 (1.28, 3.66) after birth; and 2.06 (1.24, 3.42) for global exposure. CONCLUSION: This is the first study in which an OEI was used to assess a father's occupational exposure to carcinogenic agents as a risk factor for the development of childhood AL in his offspring. From our results, we conclude that children whose fathers have been exposed to a high level of carcinogenic agents seem to have a greater risk of developing acute leukemia. However, confounding factors cannot be disregarded due to an incomplete control for confounding.
