Acute myelogenous leukemia (AML) remains a challenging disease. Although responsible for only 15-20% of childhood leukemias, it amounts to up to a 30% of all leukemia-related deaths. 1 Over the last three decades, there has been significant progress in the treatment of this disease, mostly due to the introduction of multiple drug regimens, treatment intensification, and improvements in postremission therapy. Early mortality has been addressed by a number of authors, since it is responsible for a significant proportion of all AML deaths. 1-7 In general, it is said that approximately half of early deaths are due to treatment toxicity. 1 In developing countries, such as Chile, treatment toxicity may be even higher, mostly from infectious complications. Children under 15 years comprise approximately 40% of the population of Chile, or 5 600 000 million people. Most of these patients (over 75%) receive their care through the National Health Services. Since 1987, children with the most common pediatric malignancies receive uniform standardized treatment in all of Chile. To that effect, the National Program for Antineoplastic Drugs for Children (PINDA) was founded, and is responsible for creating and supervising treatment programs for pediatric cancers and leukemia. Currently, there are 11 accredited treatment centers throughout the country, mostly in the capital, Santiago. PINDA has developed three treatment protocols for AML, on 1987, 1992, and 1998, based on Berlin-Francfort-Muenster (BFM) protocols. The objective of this publication is to analyze the results of the first two protocols, PINDA 87 and 92, both based on BFM-83, with emphasis on treatment toxicity and early mortality. All patients under 15 years of age with newly diagnosed AML in Chile, between March 1st, 1987, and July 31st, 1999, are included, with the exception of patients with Down's syndrome, secondary myeloblastic leukemia, and myelosarcoma. These patients were treated in 11 Chilean hospitals, according to the protocols described below. The diagnosis was made by morphology, and cytochemichal stains at each treating center, without a central review of pathology. Immunophenotype was studied at Hospital Salvador one center in Santiago. Cytogenetic studies were performed for a group of patients. All cases were classified according to the French-American-British classification (FAB). All patients were treated alike, with no differences for risk groups. The two treatment protocols were quite similar, both based on AML-BFM 83. 10 The first protocol, PINDA 87 was used
Background The National Chilean Pediatric Oncology Group, PINDA, reports the first prospective, nonrandomized trial for acute lymphoblastic leukemia (ALL), using a modified version of the Berlin‐Frankfurt‐Munster protocol (ALL BFM 86). The aim of this study was to classify immunophenotypes, to decrease cranial irradiation, and to assess whether this protocol would improve the survival rate. Procedure From June, 1987, to June, 1992, 444 unselected children were diagnosed with ALL. Of them, 425 were evaluable. Therapy was stratified by risk. Standard‐risk (SR) and high‐risk (HR) patients received protocols I, M, II, and maintenance therapy. Very‐high‐risk (VHR) patients received protocol E instead of protocol M. All patients received a prephase treatment consisting of prednisone and intrathecal methotrexate (MTX). HR and VHR patients received cranial irradiation (12–18 Gy). The following changes were made to the ALL BFM 86 protocol: in protocol M, MTX 1 g/m2 instead of 5 g/m2; in protocol E, citarabine 1 g/m2 instead of 2 g/m2; mithoxantrone and ifosfamide were substituted by teniposide and cyclophosphamide. Results Immunophenotypes: pro‐B‐ALL, 14%; common ALL, 67.4%; pre‐B‐ALL, 4.3%; T‐ALL, 10%; undifferentiated leukemia (AUL), 4.3%. The overall 5‐year event‐free survival (EFS) rate was 60% ± 2% (SE). The 5‐year EFS rate for each risk group was: SR 75%, HR 62%, VHR 28%, with a median follow‐up of 6.5 years (range 4.5–9.5 years). The cumulative incidence of central nervous system (CNS) relapse was 5.4%. Conclusions We have been able successfully to perform a nationwide study. Our strategy to adapt the BFM protocol to our population of patients trial was effective in improving the EFS. The immunophenotype distribution is similar to that in other reported series. Med. Pediatr. Oncol. 33:88–94, 1999. © 1999 Wiley‐Liss, Inc.
The case of a 12 years old boy with Nasopharyngeal carcinoma is presented. A cervical mass, partial atrophy of the tongue, palpebral ptosis, and paralysis of the vocal cord at the side of the mass, were the main clinical manifestations. Chemotherapy and radiotherapy treatment followed by a reduction of the cervical mass. However the tumor recurred with cerebral metastasis and the patient died. The presence of a benign or malignant cervical mass may pose particular problems in diagnosis. In the malignant group the differentiation between a nasopharyngeal carcinoma and a linfoma is very important, considering the differences in treatment and prognosis.
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