Treating Acute Leukemia During the COVID-19 Pandemic in an Environment With Limited Resources: A Multicenter Experience in Four Latin American Countries.

PURPOSE: The COVID-19 pandemic is a colossal challenge for global health; nonetheless, specific subgroups face considerably higher risks for infection and mortality. Among patients with malignant diseases, those with hematologic neoplasms are at a higher risk for poor outcomes. The objective of this study was to register treatment modifications associated with the COVID-19 pandemic and their short-term consequences in Latin America. METHODS: Multicenter, prospective, observational, cohort study including patients older than 14 years from 14 centers in four countries (Mexico, Peru, Guatemala, and Panama) who had a confirmed diagnosis of acute leukemia, and who were undergoing active treatment since the first COVID-19 case in each country until the cutoff on July 15, 2020. RESULTS: We recruited 635 patients. Treatment modifications because of the COVID-19 pandemic were reported in 40.8% of cases. The main reason for such modifications was logistic issues (55.0%) and the most frequent modification was chemotherapy delay (42.0%). A total of 13.1% patients developed COVID-19 disease, with a mortality of 37.7%. Several factors were identified as independently associated with mortality, including a diagnosis of acute myeloid leukemia (odds ratio 2.38 [95% CI, 1.47 to 3.84]; P < .001), while the use of telemedicine was identified as a protective factor (odds ratio 0.36 [95% CI, 0.18 to 0.82]; P = .014). CONCLUSION: These results highlight the collateral damage of COVID-19 in oncology patients.

Respuesta al tratamiento de primera línea de los pacientes con mieloma multiple, Instituto Nacional de Enfermedades Neoplásicas 2002-2006 / Response to first-line treatment of patients with multiple myeloma, National Institute of Neoplastic Diseases 2002-2006

Objetivo: Determinar la respuesta al tratamiento de primera linea, describir las características clínico-patológicas, estimar la sobrevida fibre de progresión (SLP), sobrevida global (SG) según protocolo y según intención de tratamiento de los pacientes con Mieloma Multiple (MM). Materiales y Métodos: Estudio observacional, retrospectivo, tipo serie de casos, descriptivo realizado en el Instituto Nacional de Enfermedades Neoplasicas. Se incluyeron los pacientes diagnosticados de MM con tratamiento de primera linea del 2002 al 2006. Se revisaron 253 historias cllnicas, /35 cumplieron criterios de selección. La estimación de las curvas de sobrevida se realizó por el metodo de Kaplan-Meier. Resultados: La mediana de edad file 59,2 años. Hubo 67 hombres (65,7%). La inmunoglobulina G file mas frecuente (4/,2%). El tratamiento más frecuente fue VAD (62,7%). 18 pacientes (17,6%) tuvieron respuesta completa (RC) y 30 (29,4%) respuesta parcial (RP). Hubo RC en 20,3% y RP en 25% de casos que recibieron VAD. La mediana de SLP fue 12 meses con sobrevida a los 5 aiios de 11,5%. La mediana de SG fue 33 meses con sobrevida a 5 ahos de 31,5%. fJ2mg (>5,5), deterioro renal, número de cursos de VAD y porcentaje de células plasmaticas mostraron menor SG. La mediana de SG por intención de tratar para VAD fue 30 meses con sobrevida a 5 años de 30,3%. Conclusiones: El tratamiento más utilizado file VAD, con respuesta global de 45%. La SLP fue 12 meses, la SG file 33 meses. Se observe menor sobrevida global con fJ2mg (>5,5), deterioro renal, porcentaje de celulas plasmáticas y número de cursos de VAD.

Objective: To determine the response to first-line treatment, describe the clinical and pathological features, estimate the progression-free survival (PFS), overall survival (OS) according to protocol and intention-to-treat patients with multiple myeloma (MM). . Materials and Methods: An observational, retrospective, case series, descriptive study conducted at the Instituto Nacional de Enfermedades Neoplasicas in Lima. We included patients diagnosed of MM with first-line treatment from 2002 to 2006. 253 medical records were reviewed, 135 met the selection criteria. The estimate of the survival curves was performed by the Kaplan-Meier method. Results: The median age was 59.2 years. There were 67 men (65.7%). immunoglobulin G was morefrequent (41.2%). The most frequent treatment was VAD (62.7%). 18 patients (176%) had a complete response (CR) and 30 (29.4%) partial response. There was CR in 20.3% of patients who received VAD. The median PFS was 12 months with 5-year survival of 11.5%. The median OS was 33 months with 5-year survival of 31.5%. The fJ2mg (> 5.5), renal impairment, the number of courses of VAD and the percentage of plasma cells were significantly showed lower Os. The median OS by intention to treat (1TT) VAD was 30 months with 5-year survival of 30.3%. Conclusions: The most common treatment was VAD, with overall response of 45%. PFS was 12 months, OS was 33 months. Lower overall survival was observed with fJ2mg (> 5.5), renal impairment, plasma cell percentage and number of courses of VAD.

Tumor de células germinales de ovario en dos hermanas con retardo mental / Ovarian germ cells tumors in two sisters with mental retardation

Los tumores de células germinales son neoplasias potencialmente curables, poco frecuentes y pueden estar relacionadas con disgenesia gonadal. En este artículo se presentan 2 casos de pacientes con tumores germinales de ovario en hermanas de 21 y 22 años de edad con retardo mental.

Germinal cells tumors are neoplasm potentially curable, less frequent and can be related with gonadal dysgenesis. In this article we show 2 cases of patients with germinal tumors of the ovary in sisters of 21 and 22 years old with mental retardation.

Compromiso leptomeníngeo en cáncer de mama: opciones terapéuticas actuales / Leptomeningeal involvement in breast cancer: current therapeutic options

El Cáncer de Mama sigue siendo una causa importante de muerte en mujeres en el mundo. En el Perú representa la segunda neoplasia más común en mujeres. El desarrollo de metástasis en el sistema nervioso central es una de las consecuencias más devastadoras de la progresión de la neoplasia. La carcinomatosis leptomeníngea ocurre en el 3.5% a 5% de los pacientes con Cánceres de Mama avanzado. Hay factores de riesgo para el desarrollo de la misma, como edad temprana al diagnóstico, metástasis pulmonar previa, Cáncer de Mama triple negativo, sobre expresión de HER-2, entre otros. El cuadro clínico generalmente es multifocal y debe ir acompañado del hallazgo de células neoplásicas en el líquido cefalorraquídeo, aunque esta tiene un nivel de sensibilidad bajo. Además se puede evidenciar hallazgos en resonancia magnética que nos orienten al diagnóstico. En los últimos 20 años las pacientes con Cáncer de Mama han experimentado un aumento en el tiempo de sobrevida, gracias al avance de los tratamientos sistémicos. Sin embargo, debido a esta causa existe un incremento en la incidencia de metástasis cerebrales, lo mismo que en la carcinomatosis leptomeníngea. Actualmente se tienen escasas opciones terapéuticas con poco impacto en el tiempo de sobrevida. El tratamiento se orienta más hacia buscar una adecuada calidad de vida. Aún faltan más estudios que respalden los buenos resultados de capecitabina, trastuzumab, lapatinib y ARA-C liposomal, encontrados en reportes aislados para definir un tratamiento estándar.

Breast cancer remains a major cause of death in women worldwide. In Peru it is second most common malignancy among women. The development of metastases in the central nervous system is one of the most devastating consequences of the progression of disease. Leptomeningeal carcinomatosis occurs in 3.5 to 5% of patients with advanced breast cancers, there are risk factors for developing it such as: early age at diagnosis, previous lung metastases, triple negative breast cancer, overexpression of HER -2, among others. The clinical picture is usually multifocal and mustbe accompanied by the presence of neoplastic cells in the cerebrospinal fluid, although this is anunusual finding. Magnetic resonance imaging findings can help in the diagnosis. In the past 20 years, breast cancer patients have experienced an increase in survival time, due to improvement insystemic treatments, however in relation to this there is an increasing incidence of brain metastases, and leptomeningeal carcinomatosis. Currently there are few treatment options with little impact onsurvival time, treatment being more oriented toward improving quality of life. We need more studies to support the success of capecitabine, trastuzumab, lapatinib and liposomal ARA-C are found inisolated reports to define a standard treatment.