A chemotherapy only therapeutic approach to pediatric Hodgkin lymphoma: AHOPCA LH 1999

Castellanos, Enrique; Barrantes, José; Báez, Luís; Gamboa, Yessica; Peña, Armando; Alabi, Soad Fuentes; Bonilla, Miguel; Wang, Huaping; Metzger, Monika L.; Alarcón, Pedro A. de

doi:10.1002/pbc.24905

Cited by 28 publications

(30 citation statements)

References 14 publications

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“…The low rate of treatment abandonment, lower than in many other LMICs, reflects the tenacity of the clinical teams and the assistance of non‐profit organisations in augmenting psycho‐social services. The 5‐year OS rate of 79% is encouraging for a middle‐income country with a fragmented healthcare system.…”

Section: Discussionmentioning

confidence: 96%

Treatment outcomes of children with Hodgkin lymphoma between 2000 and 2010: First report by the South African Children's Cancer Study Group

Geel

Chirwa

Rowe

et al. 2017

Pediatric Blood & Cancer

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Section: Discussionmentioning

confidence: 96%

Treatment outcomes of children with Hodgkin lymphoma between 2000 and 2010: First report by the South African Children's Cancer Study Group

Geel

Chirwa

Rowe

et al. 2017

Pediatric Blood & Cancer

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“…[ 2 , 14 – 16 ] However, experience demonstrates that when baseline income inequalities and frequency of TxA are high, a significant number of patients with lymphoma and Wilms tumor abandon therapy. [ 17 – 24 ] For these common and curable childhood cancers, even small percentages of TxA may be significant in crude numbers. Furthermore, there is no inherent mechanism by which having a specific diagnosis should cause TxA.…”

Section: Discussionmentioning

confidence: 99%

Determinants of Treatment Abandonment in Childhood Cancer: Results from a Global Survey

et al. 2016

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BackgroundUnderstanding and addressing treatment abandonment (TxA) is crucial for bridging the pediatric cancer survival gap between high-income (HIC) and low-and middle-income countries (LMC). In childhood cancer, TxA is defined as failure to start or complete curative cancer therapy and known to be a complex phenomenon. With rising interest on causes and consequences of TxA in LMC, this study aimed to establish the lay-of-the-land regarding determinants of TxA globally, perform and promote comparative research, and raise awareness on this subject.MethodsPhysicians (medical oncologists, surgeons, and radiation therapists), nurses, social workers, and psychologists involved in care of children with cancer were approached through an online survey February-May 2012. Queries addressed social, economic, and treatment-related determinants of TxA. Free-text comments were collected. Descriptive and qualitative analyses were performed. Appraisal of overall frequency, burden, and predictors of TxA has been reported separately.Results581 responses from 101 countries were obtained (contact rate = 26%, cooperation rate = 70%). Most respondents were physicians (86%), practicing pediatric hematology/oncology (86%) for >10 years (54%). Providers from LMC considered social/economic factors (families’ low socioeconomic status, low education, and long travel time), as most influential in increasing risk of TxA. Treatment-related considerations such as preference for complementary and alternative medicine and concerns about treatment adverse effects and toxicity, were perceived to play an important role in both LMC and HIC. Perceived prognosis seemed to mediate the role of other determinants such as diagnosis and treatment phase on TxA risk. For example, high-risk of TxA was most frequently reported when prognosis clearly worsened (i.e. lack of response to therapy, relapse), or conversely when the patient appeared improved (i.e. induction completed, mass removed), as well as before aggressive/mutilating surgery. Provider responses allowed development of an expanded conceptual model of determinants of TxA; one which illustrates established and emerging individual, family, center, and context specific factors to be considered in order to tackle this problem. Emerging factors included vulnerability, family dynamics, perceptions, center capacity, public awareness, and governmental healthcare financing, among others.ConclusionTxA is a complex and multifactorial phenomenon. With increased recognition of the role of TxA on global pediatric cancer outcomes, factors beyond social/economic status and beliefs have emerged. Our results provide insights regarding the role of established determinants of TxA in different geographical and economic contexts, allow probing of key determinants by deliberating their mechanisms, and allow building an expanded conceptual model of established and emerging determinants TxA.

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“…17 For the past 20 years, pediatric oncologists from Guatemala, El Salvador, Honduras, Nicaragua, Costa Rica, Panama, the Dominican Republic, and Haiti (as members of AHOPCA, the Asociación de Hemato-Oncología Pediátrica de Centro América) have been working collaboratively to standardize treatment regimens across multiple institutions to improve therapy for children with cancer. 18,19 Here we report the results of a retrospective review of multisite experience with a common treatment strategy adapted from the Berlin-Frankfurt-Münster (BFM) protocol for children with a clinicopathologic diagnosis of B-NHL, as used by institutions in six Central American countries.…”

Section: Introductionmentioning

confidence: 99%

Outcome of pediatric non‐Hodgkin lymphoma in Central America: A report of the Association of Pediatric Hematology Oncology of Central America (AHOPCA)

Peña‐Hernandez

Ortiz

Garrido

et al. 2019

Pediatric Blood & Cancer

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Background Treating B–non‐Hodgkin lymphoma (B‐NHL) in lower‐income countries is challenging because of imprecise diagnosis, the increased risk of fatal toxicity associated with advanced disease at presentation, and limited supportive care. Procedure Central American patients with newly diagnosed stage I or II B‐NHL received a modified Berlin–Frankfurt–Münster (BFM) regimen including a prephase (prednisone, cyclophosphamide) followed by A/B/A courses (A: cytarabine, dexamethasone, etoposide, ifosfamide, methotrexate, and intrathecal therapy; B: cyclophosphamide, dexamethasone, doxorubicin, methotrexate, and intrathecal therapy). Those with stage III or IV NHL received additional courses (B/A/B), intensified for stage IV disease by additional vincristine and methotrexate doses. Patients in poor condition received a second prephase treatment before their chemotherapy courses. Results Between March 2004 and June 2016, of 405 patients with B‐NHL, 386 (109 females) were eligible for treatment. Immunohistochemistry was performed in 177 cases (47.4%) and characterized the disease as mature B‐cell lymphoma. Stage distribution was as follows: I/II, 31 (8.1%); III, 252 (65.3%); IV, 93 (24.1%); 10 (2.6%) not available. The 3‐year overall survival was 70% for the whole group (86% for stages I/II, 75% for stage III, 58% for stage IV). Events included death during induction (34 patients, 8.8%), relapse/progression (46, 11.9%), death in remission (9, 2.3%), second malignancy (1, 0.26%), and death of unknown cause (1, 0.26%). Twenty‐three (6%) patients abandoned or refused therapy. Conclusions Approximately 70% of children with B‐NHL from Central America experienced long‐term, disease‐free survival with a modified BFM schedule. Toxic death and relapse/resistant disease were the main reasons for treatment failure.

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A chemotherapy only therapeutic approach to pediatric Hodgkin lymphoma: AHOPCA LH 1999

Cited by 28 publications

References 14 publications

Treatment outcomes of children with Hodgkin lymphoma between 2000 and 2010: First report by the South African Children's Cancer Study Group

Treatment outcomes of children with Hodgkin lymphoma between 2000 and 2010: First report by the South African Children's Cancer Study Group

Determinants of Treatment Abandonment in Childhood Cancer: Results from a Global Survey

Outcome of pediatric non‐Hodgkin lymphoma in Central America: A report of the Association of Pediatric Hematology Oncology of Central America (AHOPCA)

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