Treatment of Pediatric Cancer in Central America Impact of AHOPCA on - - PowerPoint PPT Presentation

Raul C. Ribeiro, MD Department of Oncology Division of Leukemia Lymphoma

• St. Jude Children’s Research Hospital

Treatment of Pediatric Cancer in Central America Impact of AHOPCA on Survival

Cure4Kids

POGO

AHOPCA

• Association of Central American

Pediatric Hematologists/Oncologists

• Begun at the Milan International School
• f Pediatric Hematology/Oncology in

1998

• Many shared projects: annual meetings,

research projects, protocols, drug- purchasing consortium, etc.

1800 cases of pediatric cancer and 20 pediatric oncologists

Honduras: 168 ALL patients (1999-2002)

Causes of Early Treatment Failure Total Before induc. During induc. During contin. n (%)

n (%) n (%) n (%)

Death (all causes) 35 (21) 5 (3) 15 (9) 15 (9) Infection or sepsis 19 (11) 1 10 8 Hemorrhage 6 (4) 1 3 2 Other causes* 10 (6) 3 3 4 Treatment abandoned 36 (21) 1 (0.6) 13 (8) 22 (13)

*Tumor lysis syndrome, MTX toxicity, adrenal insufficiency, SVC syndrome

Rationale

• Cure rates of most pediatric cancers have increased
• ver the past 30 years in developed countries—70%
• Survival rates in developing countries varies from

10% to 50%

• Most nations will continue to improve their general

health status

• Mortality in children age <5 years is decreasing

(Rate in El Salvador fell 3.9% per year, 1990- 2001)

Statement

“The therapies available for pediatric cancer in economically advanced countries are truly life-saving and therefore must be considered a fundamental right of all affected children.”

Tonogni, G. 2002

AHOPCA Highlights

• Latin American nurse training program
• Hematology/oncology fellowship program
• AFINCA
• Diagnosis: Immunophenotyping program and

pathology training, referral of samples

• Ongoing protocols (ALL, AML, APL, Hodgkin

lymphoma, RMS, Wilms, RB)

• Infrastructure improvement programs (New

units in Guatemala and Honduras, satellite clinic in Honduras)

Hematology/Oncology Fellowship

• 3-year program in Guatemala for

Central America countries

• Support of training of

pediatric hematologists/

• ncologists
• Major problem is salary

support after graduation

Honduras Pediatric Oncology Center El Salvador Pediatric Oncology Center Guatemala Pediatric Oncology Center Flow Cytometry Laboratory (Guatemala)

Bone marrow samples (overnight shipping)

Worldwide Web Site Flow Cytometry Laboratory (St. Jude)

Flow cytometry data (file transfer protocol) Feedback, discussion (telephone, email, real-time computer connection to flow cytometer) Flow cytometry data (file transfer protocol)

Diagnosis: Immunophenotyping Program

Bone marrow samples (local shipping)

RECLUTAMI ENTO POR AÑO DE DI AGNÓSTI CO

AÑO DE DIAGNÓSTICO

CR ES HO NI

TOTAL 2008 (5 meses) 18 11 26 24 79 2009 47 74 124 76 321 2010 50 76 88 72 286 2011 53 76 91 89 309 2012 49 81 112 72 314 2013 50 73 85 84 292 2014 41 61 127 73 302 2015 37 74 101 75 287 2016(10 meses) 8 20 26 19 73 TOTAL 353 546 780 584 2263

OUTCOME POR TRATAMI ENTO ADMI NI STRADO

PRIMER EVENTO RS RI RA/RA+rtc TOTAL N % N % N % N % EN ESTUDIO

595 896 772 2263

FALLECIDO, EN INDUCCIÓN

12 2.0 24 2.7 38 4.9 74 3.3

ABANDONO, EN INDUCCIÓN

12 2.5 13 1.5 19 2.5 47 2.1

RESISTENTE

32 4.2 32 1.4

EN CR AL FINAL DE LA INDUCCIÓN

568 95.5 859 95.9 683 88.5 2110 93.2

ABANDONO, EN CR

41 6.9 69 7.7 50 6.5 160 7.1

RECAÍDA

118 19.8 235 26.2 229 29.7 582 25.7

En terapia

54 9.1 143 16.0 150 19.4 347 15.3

Fuera terapia

64 10.8 92 10.3 79 10.2 235 10.4

• Medula Ósea

72 61.0 155 66.0 160 69.9 387 66.5

• Extra-medular

27 22.9 65 27.7 52 22.7 144 24.7

• Combinado

18 15.3 15 6.4 16 7.0 49 8.4

• Desconocido

1 0.9

• 1

0.4 2 0.3

SNM

• 1

0.1 1 0.0

FALLECIDO, EN CR

9 1.5 37 4.1 30 3.9 76 3.4

VIVO, EN CCR

383 64.4 508 56.7 362 46.9 1253 55.4

TRASLADO/PERDIDO AL SEG.

17 2.9 10 1.1 11 1.4 38 1.7

Años desde el diagnóstico SLE N pts en riesgo=2263*/972 eventos ST N pts en riesgo=2263*/761eventos %SLE ES N pts “at risk” %ST ES N pts “at risk” 1 79.3 0.9 1712 84.9 0.8 1829 2 67.8 1.0 1262 75.1 0.9 1398 3 58.6 1.1 887 69.3 1.0 1048 4 52.4 1.2 609 64.0 1.1 749 5 50.2 1.2 443 60.9 1.2 537 6 49.1 1.3 277 59.2 1.3 335 7 48.5 1.3 147 57.7 1.4 170 8 47.8 1.4 27 56.9 1.4 29

Años desde el diagnóstico Costa Rica N=353/100 El Salvador N=546/195 Honduras N=780/369 Nicaragua N=584/308 %EFS ES N %EFS ES N %EFS ES N %EFS ES N 1 93.8 1.3 329 85.6 1.5 447 73.7 1.6 546 71.9 1.9 390 2 87.1 1.8 269 75.0 1.9 330 62.4 1.8 391 56.4 2.1 272 3 77.0 2.4 204 65.4 2.2 235 53.8 1.9 257 47.0 2.2 191 4 67.1 2.8 145 60.5 2.4 172 47.5 2.1 167 42.5 2.3 125 5 65.6 2.9 111 57.6 2.5 119 44.4 2.2 111 41.0 2.3 102 6 65.6 2.9 78 54.3 2.8 59 43.1 2.2 66 41.0 2.3 74 7 65.6 2.9 44 54.3 2.8 21 42.2 2.4 38 39.9 2.4 44 8 65.6 2.9 18 NE NE 42.2 2.4 2 38.4 2.7 7

Años desde el diagnóstico RS N=595/195 eventos RI N=869/378 eventos RA/RA+rtc N=772/399 eventos %EFS ES N %EFS ES N %EFS ES N 1 85.5 1.5 495 81.4 1.3 692 71.9 1.6 525 2 78.2 1.7 403 68.6 1.6 501 58.6 1.8 358 3 69.2 2.0 282 59.1 1.8 356 49.4 2.0 249 4 64.7 2.2 207 53.3 1.9 245 41.5 2.1 157 5 63.3 2.2 157 50.3 2.0 177 39.4 2.1 109 6 61.0 2.4 102 50.0 2.0 107 38.5 2.1 68 7 59.6 2.5 65 49.5 2.0 50 38.5 2.1 32 8 59.6 2.5 12 47.6 2.7 7 38.5 2.1 8

9 años de reclutamiento

01/07/2007 hasta el 30/06/2016 Seguimiento actualizado en 16 de Enero 2017

Conclusions

• Improved outcome in pediatric cancer in

Central America is result of a multidisciplinary approach

• Alliance of multiple partners allowed for

relatively rapid progress

• Cooperation and collaboration are

essential for success