Chromosome abnormalities that usually define high-risk acute lymphoblastic leukemia
are the t(9;22)/ breakpoint cluster region protein-Abelson murine leukemia viral
oncogene homolog 1, hypodiploid with < 44 chromosomes and 11q23/ myeloid/lymphoid
leukemia gene rearrangements. The spectrum of acute lymphoblastic leukemia genetic
abnormalities is nevertheless rapidly expanding. Therefore, newly described
chromosomal aberrations are likely to have an impact on clinical care in the near
future. Recently, the rare intrachromosomal amplification of chromosome 21 started to
be considered a high-risk chromosomal abnormality. It occurs in approximately 2-5% of
pediatric patients with B-cell precursor acute lymphoblastic leukemia. This
abnormality is associated with a poor outcome. Hence, an accurate detection of this
abnormality is expected to become very important in the choice of appropriate
therapy. In this work the clinical and molecular cytogenetic evaluation by
fluorescence in situ hybridization of a child with B-cell precursor acute
lymphoblastic leukemia presenting the rare intrachromosomal amplification of
chromosome 21 is described.
Purpose
The purpose of this study was to analyze the effect of hospital care volume on the overall survival of children with cancer in Southern Brazil.
Patients and Methods
We performed a retrospective cohort study of 1378 cancer patients aged 0‐19 years, diagnosed with cancer between August 1, 2009 and December 31, 2015 in Rio Grande do Sul, who received hospital treatment in institutions affiliated with the Universal Health Care System (Sistema Único de Saúde [SUS]).
Results
Most children and adolescents were male (56.9%) and White (75.8%). The most common types of cancer in our cohort were acute leukemia (40.7%), followed by lymphoma (15.9%) and central nervous system tumors (8.8%). Ninety‐five percent of the patients were treated in specialized pediatric oncology centers. The cumulative probability of survival at 5 years for all patients was 73.8% (95% confidence interval [CI] 71.4‐76.0%). Survival was significantly higher for patients younger than 4 years of age (P = .012) compared to all other age groups. Patients treated in institutions with a pediatric oncology patient volume of less than 15 patients/year were 41% more likely to die than patients treated in institutions with a volume of 60 patients/year or more (P = .029).
Conclusion
Cancer is the leading cause of death by natural causes in all age groups in Brazil, but, even so, childhood tumors are rare. This complexity makes childhood cancer care a challenge. In this study, we reiterate that pediatric cancer patients demonstrate better overall survival when treated in high‐volume hospitals.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.