Abstract:Pediatric oncology is the sub-specialty which has advanced the most over the last 30 years. A period during which the majority of the specialist centers in Brazil were inaugurated. At all of these centers, leukemias occupy a position of prominence among malign diseases, being predominantly (95-98%) acute. Lymphoid leukemias make up 70 -80% of these. Of the chronic forms of leukemia, only myeloid is manifest among children and adolescents.There are three pathologies that are frustrating to those who work in ped… Show more
“…The most common referring misdiagnosis in the literature is JIA, especially the systemic onset subtype. [15][16][17][18] RF was the most frequent rheumatologic diagnostic described in this series of patients, in disagreement with other authors who refer to JIA as the most important rheumatologic differential diagnostic. [19][20][21][22] The incidence of RF in the developing countries may be 100 to 206/ 100,000 children, with a prevalence of 2.1/1000 poor families.…”
“…The most common referring misdiagnosis in the literature is JIA, especially the systemic onset subtype. [15][16][17][18] RF was the most frequent rheumatologic diagnostic described in this series of patients, in disagreement with other authors who refer to JIA as the most important rheumatologic differential diagnostic. [19][20][21][22] The incidence of RF in the developing countries may be 100 to 206/ 100,000 children, with a prevalence of 2.1/1000 poor families.…”
“…6 As mais comuns são as agudas, predominantemente as linfóides (LLA), que correspondem por 70% a 80% dos casos e, em menor número, as mielóides (LMA), compreendendo apenas 15%. 1,7 A única leucemia crônica que se manifesta em crianças e adolescentes é a de origem mielóide (LMC), 7 representando menos de 1% das leucemias pediátricas. 8 Uma das principais complicações do paciente leucêmico é a imunossupressão decorrente da própria doença e/ ou induzida pela quimioterapia.…”
“…Many patients do not undergo a proper cytogenetic and molecular evaluation and classification of their disease at diagnosis, and they may not be treated using standardized treatment protocols. In these countries, there is a limited number of hospital beds available for chemotherapy or transplantation, and optimal supportive care and management of comorbidities may not be available, compromising cure rates and increasing the risks associated with these complex and expensive procedures [13][14][15][16][17][18] .…”
The survival rates of children with high-risk acute myeloid leukemia (AML) treated with hematopoietic stem cell transplant (HSCT) range from 60% to 70% in high-income countries. The corresponding rate for Brazilian children with AML who undergo HSCT is unknown. We conducted a retrospective analysis of 114 children with AML who underwent HSCT between 2008 and 2012 at institutions participating in the Brazilian Pediatric Bone Marrow Transplant Working Group. At transplant, 38% of the children were in first complete remission (CR1), 37% were in CR2, and 25% were in CR3+ or had persistent disease. The donors included 49 matched-related, 59 matched-unrelated, and six haploidentical donors. The most frequent source of cells was bone marrow (69%), followed by the umbilical cord (19%) and peripheral blood (12%). The 4-year overall survival was 47% (95% confidence interval [CI] 30%–57%), and the 4-year progression-free survival was 40% (95% CI 30%–49%). Relapse occurred in 49 patients, at a median of 122 days after HSCT. There were 65 deaths: 40 related to AML, 19 to infection, and six to graft versus host disease. In conclusion, our study suggests that HSCT outcomes for children with AML in CR1 or CR2 are acceptable and that this should be considered in the overall treatment planning for children with AML in Brazil. Therapeutic standardization through the adoption of multicentric protocols and appropriate supportive care treatment will have a significant impact on the results of HSCT for AML in Brazil and possibly in other countries with limited resources.
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