RESUMO
OBJECTIVE: To evaluate the progress achieved in the treatment of acute lymphoblastic leukemia (ALL) in our hospital. MATERIAL AND METHODS: A total of 235 patients diagnosed with ALL in the central region of Cuba from 1972 to 2000 were included. Four groups were considered according to the diagnostic period and treatment protocol. Group 1 was composed of 20 patients who did not receive a uniform treatment regimen. The remaining groups were treated with different protocols of the Latin American Group for Malignant Hemopathy Therapy (Glathem). Group 2 was treated with less aggressive classical regimens from the 1970s, and groups 3 and 4 received more aggressive regimens, type Berlin-Frankfurt-Munster (BFM). Intravenous high-dose methotrexate was used in group 4 but not in group 3. Classification by prognostic groups was based on age and leukocyte count. RESULTS: Of 215 patients included in the Glathem protocols, remission occurred in 197 (91.6%). Overall survival in the distinct treatment groups progressively increased during the study period, from a 5-year survival of 15% in group 1 to 72% in group 4. Event-free survival in patients included in the Glathem protocols increased from 42% in group 2 (classical protocols) to 68.7% in the BFM protocols (groups 3 and 4). Significant differences were found among the different treatment and prognostic groups considered. CONCLUSIONS: During the period analyzed, survival in children with ALL progressively increased in parallel with improved treatment regimens. These results demonstrate the importance of well-programmed polychemotherapy to achieve prolonged survival and a high percentage of cure in this disease.
Assuntos
Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/mortalidade , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Criança , Pré-Escolar , Humanos , Lactente , Análise de SobrevidaRESUMO
Objetivo Analizar los progresos obtenidos en el tratamiento de la leucemia linfoblástica aguda (LLA) en nuestro centro. Material y métodos Se incluyen en este estudio un total de 235 pacientes diagnosticados de LLA en la región central de Cuba de 1972 a 2000. Se consideraron 4 grupos según el período de diagnóstico y protocolo de tratamiento. El grupo 1 está constituido por 20 pacientes que no recibieron un esquema de tratamiento uniforme. Los restantes grupos fueron tratados con distintos protocolos del Grupo Latinoamericano de Tratamiento de Hemopatías Malignas (Glathem). El grupo 2 fue tratado con esquemas clásicos poco agresivos, de la década de 1970 y los grupos 3 y 4 recibieron esquemas más agresivos, tipo BFM. En el grupo 4 se utilizó metotrexato intravenoso en dosis elevadas, pero no en el grupo 3. La clasificación por grupos pronósticos se hizo según a la edad y la cifra de leucocitos. Resultados De 215 pacientes incluidos en los protocolos del Glathem hicieron remisión 197 (91,6 por ciento). El análisis de la supervivencia global en los distintos grupos de tratamiento muestra un incremento progresivo en el período analizado, desde el 15 por ciento de supervivencia a los 5 años en el grupo 1 hasta el 72 por ciento en el grupo 4. La supervivencia libre de eventos en los pacientes incluidos en los protocolos del Glathem se elevó de 42 por ciento en el grupo 2 (protocolos clásicos) al 68,7 por ciento en los protocolos BFM (grupos 3 y 4). Existen diferencias significativas entre los distintos grupos de tratamiento y los distintos grupos pronósticos considerados. Conclusiones Durante el período analizado se ha producido un incremento progresivo de la supervivencia de niños diagnosticados de LLA a medida que se han ido perfeccionando los esquemas terapéuticos. Esto demuestra la importancia de una poliquimioterapia bien programada para obtener supervivencias prolongadas y un elevado porcentaje de curación en esta enfermedad(AU)
OBJECTIVE: To evaluate the progress achieved in the treatment of acute lymphoblastic leukemia (ALL) in our hospital. MATERIAL AND METHODS: A total of 235 patients diagnosed with ALL in the central region of Cuba from 1972 to 2000 were included. Four groups were considered according to the diagnostic period and treatment protocol. Group 1 was composed of 20 patients who did not receive a uniform treatment regimen. The remaining groups were treated with different protocols of the Latin American Group for Malignant Hemopathy Therapy (Glathem). Group 2 was treated with less aggressive classical regimens from the 1970s, and groups 3 and 4 received more aggressive regimens, type Berlin-Frankfurt-Munster (BFM). Intravenous high-dose methotrexate was used in group 4 but not in group 3. Classification by prognostic groups was based on age and leukocyte count. RESULTS: Of 215 patients included in the Glathem protocols, remission occurred in 197 (91.6 percent). Overall survival in the distinct treatment groups progressively increased during the study period, from a 5-year survival of 15percent in group 1 to 72 percent in group 4. Event-free survival in patients included in the Glathem protocols increased from 42 percent in group 2 (classical protocols) to 68.7percent in the BFM protocols (groups 3 and 4). Significant differences were found among the different treatment and prognostic groups considered. CONCLUSIONS: During the period analyzed, survival in children with ALL progressively increased in parallel with improved treatment regimens. These results demonstrate the importance of well-programmed polychemotherapy to achieve prolonged survival and a high percentage of cure in this disease(AU)
Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/mortalidade , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Análise de SobrevidaRESUMO
INTRODUCTION: Ischemic cerebrovascular disease includes a set of entities that are produced by disorders in components of the blood, the blood flow, the walls of blood vessels or the heart, and can be anatomical, functional or even mixed. CASE REPORT: We describe the case of an 18-month-old male patient with compensated celiac disease, with repeated ischemic strokes in different territories, including the right posterior cerebral artery and middle cerebral artery, in the course of a hypercoagulable state due to essential thrombocytosis. Computerised axial tomography scans, brain angioresonance, a complete blood chemistry analysis and bone marrow biopsy were all performed and confirmed the previous diagnosis. Exchange transfusion, antiplatelet drugs and a platelet production inhibitor (anagrelide) were begun as therapy. At present, the patient is 2 years old and still has a slight direct hemiparesis, which is complete and predominantly faciobrachial, with no alterations to language. CONCLUSIONS: Cerebral infarctions in infancy are infrequent, and their presentation obliges the attending clinician to seek causes that are not usual. In our patient the hypocoagulability came about due to essential thrombosis, which is rare in infancy. The cause behind the infarction determines the chances of its recurring. Acetylsalicylic acid did not prove to be effective for this purpose. We suggest using carbamazepine for the treatment of kinesigenic dystonias.
Assuntos
Isquemia Encefálica/etiologia , Infarto da Artéria Cerebral Posterior/etiologia , Trombocitose/complicações , Humanos , Lactente , Masculino , RecidivaRESUMO
Se estudiaron 205 niños con leucemia linfoide aguda tratado con 3 esquemas terapéuticos. De los 205 pacientes, 191 (93,1) alcanzaron la remisión completa. La duración de la remisión completa a los 60 meses, según el método de la sobrevida actuarial, fue del 31 y al de la sobrevida el 38. Los factores pronósticos más importantes fueron: edad en el momento del diagnóstico, cifra inicial de leucocitos y coloración de PAS en los linfoblastos. La duración de la remisión completa a los 60 meses en niños menor o igual a 10 años fue del 35 y en los de mayor de 10 años, el 17, en aquellos con menor o igual a 50 x 10