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Background and aims: Pediatric acute lymphoblastic leukemia (ALL) survival rates in low- and middle-income countries are lower due to deficiencies in multilevel factors, including access to timely diagnosis, risk-stratified therapy, and comprehensive supportive care. This retrospective study aimed to analyze outcomes for pediatric ALL at 16 centers in Mexico. Methods: Patients <18 years of age with newly diagnosed B- and T-cell ALL treated between January 2011 and December 2019 were included. Clinical and biological characteristics and their association with outcomes were examined. Results: Overall, 2,116 patients with a median age of 6.3 years were included. B-cell immunophenotype was identified in 1,889 (89.3%) patients. The median white blood cells at diagnosis were 11.2.5 × 103/mm3. CNS-1 status was reported in 1,810 (85.5%), CNS-2 in 67 (3.2%), and CNS-3 in 61 (2.9%). A total of 1,488 patients (70.4%) were classified as high-risk at diagnosis. However, in 52.5% (991/1,889) of patients with B-cell ALL, the reported risk group did not match the calculated risk group allocation based on National Cancer Institute (NCI) criteria. Fluorescence in situ hybridization (FISH) and PCR tests were performed for 407 (19.2%) and 736 (34.8%) patients, respectively. Minimal residual disease (MRD) during induction was performed in 1,158 patients (54.7%). The median follow-up was 3.7 years. During induction, 191 patients died (9.1%), and 45 patients (2.1%) experienced induction failure. A total of 365 deaths (17.3%) occurred, including 174 deaths after remission. Six percent (176) of patients abandoned treatment. The 5-year event-free survival (EFS) was 58.9% ± 1.7% for B-cell ALL and 47.4% ± 5.9% for T-cell ALL, while the 5-year overall survival (OS) was 67.5% ± 1.6% for B-cell ALL and 54.3% ± 0.6% for T-cell ALL. The 5-year cumulative incidence of central nervous system (CNS) relapse was 5.5% ± 0.6%. For the whole cohort, significantly higher outcomes were seen for patients aged 1-10 years, with DNA index >0.9, with hyperdiploid ALL, and without substantial treatment modifications. In multivariable analyses, age and Day 15 MRD continued to have a significant effect on EFS. Conclusion: Outcomes in this multi-institutional cohort describe poor outcomes, influenced by incomplete and inconsistent risk stratification, early toxic death, high on-treatment mortality, and high CNS relapse rate. Adopting comprehensive risk-stratification strategies, evidence-informed de-intensification for favorable-risk patients and optimized supportive care could improve outcomes.
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Debido al aumento de la tasa de fecundidad en las adolescentes, el interés por las posibles complicaciones también ha aumentado. Varios estudios concluyen que el embarazo en las edades extremas del periodo reproductivo, son un factor de riesgo para complicaciones en los recién nacidos. Otros estudios no encuentran asociación entre éstas. El objetivo de este trabajo fue analizar la relación de complicaciones en recién nacidos de madres adolescentes tempranas (10-14 años)comparada a los de madres adultas entre 20 a 35 años atendidas en el HNAL. Resultados: Del total (16,601) de nacidos, 62 (0.37%) fueron hijos de madres adolescentes tempranas. Sobre el peso al nacer, la mayoría tuvo un peso adecuado (87.1% y 80.6% respectivamente). Sobre el peso para la edad gestacional, 85.5% y 72.6% fueron adecuados. En edad gestacional, 90.3% de ambos grupos, fueron a término. Parto vaginal se dio 82.3% y 69.4% en cada grupo. 32.3% y 19.4% no tuvieron adecuado control prenatal. Ictericia no presentó en 95.2% y 96.8% respectivamente. Sepsis en 93.5% y 96.8%. No Complicación respiratoria en 96.8% en ambos grupos. Complicaciones mecánicas 90.3% y 95.2%. Conclusiones: La frecuencia de recién nacidos de madres adolescentes tempranas es menor a la estadística nacional. No existió diferencia entre las complicaciones de los recién nacidos de madres adolescentes tempranas en relación a los de madres entre 20 a 35 años...
Due to the increase in fertility rate in teenagers, the interest in knowing the possible complications in the newborns also has increased. Several studies discovered that pregnancy in extreme ages is considered a risk factor for complications in newborns. Other studies have not identified a correlation between teenage pregnancy and complications Material and Methods: Analytic, retrospective cohort study. The population is the total amount of newborns of early teens plus the same amount of mothers between the ages of 20 and 35 years. Results: From the total of newborns (16 601), 0.37% were part of the early teenagers group. 87.1% of the early teens and 72.6% of the adults mothers group were born within the normal weight range. 90.3% of both groups were born to term in 93.5 %and 96.8% respectively, presented jaundice. Sepsis was present in 95.2 % and 96.8% respectively. Respiratory complications present in 96.8 of both groups. Mechanic complications in 90.3 % and 95.2%, respectively. Conclusions: The frequency of newborns of early teens was less than national reports. There is no difference between the complicantios of newborns of early teenagers compared to the newborn of mothers between 20 and 35 years old...