The “Golden Hour”: a capacity-building initiative to decrease life-threating complications related to neutropenic fever in patients with hematologic malignancies in low- and middle-income countries

Ornelas-Sánchez, Mario; Nuño-Vázquez, Laura; Loera-Reyna, Adriana; Torres-Reyes, Dara; Rivera-Gómez, Rebeca; Sánchez, Alicia; Romano, Mitzy; González, Miriam; Caniza, Miguela; Aristizabal, Paula

doi:10.1182/bloodadvances.2018gs112240

Cited by 7 publications

(6 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The estimated 5-year overall survival for ALL in Mexico is approximately 60% ( 9 – 11 ). Adverse outcomes have been associated with late presentation, delayed diagnosis, malnutrition ( 12 ), infection-related deaths ( 13 ), and abandonment ( 14 ). In Mexico, between 2004 and 2019, Seguro Popular provided health coverage to the population without social security or private insurance, including financing care for children and adolescents with ALL.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of factors leading to poor outcomes for pediatric acute lymphoblastic leukemia in Mexico: a multi-institutional report of 2,116 patients

Moreira,

González-Ramella,

Echavarría Valenzuela

et al. 2023

Front. Oncol.

View full text Add to dashboard Cite

Background and aimsPediatric acute lymphoblastic leukemia (ALL) survival rates in low- and middle-income countries are lower due to deficiencies in multilevel factors, including access to timely diagnosis, risk-stratified therapy, and comprehensive supportive care. This retrospective study aimed to analyze outcomes for pediatric ALL at 16 centers in Mexico.MethodsPatients <18 years of age with newly diagnosed B- and T-cell ALL treated between January 2011 and December 2019 were included. Clinical and biological characteristics and their association with outcomes were examined.ResultsOverall, 2,116 patients with a median age of 6.3 years were included. B-cell immunophenotype was identified in 1,889 (89.3%) patients. The median white blood cells at diagnosis were 11.2.5 × 103/mm3. CNS-1 status was reported in 1,810 (85.5%), CNS-2 in 67 (3.2%), and CNS-3 in 61 (2.9%). A total of 1,488 patients (70.4%) were classified as high-risk at diagnosis. However, in 52.5% (991/1,889) of patients with B-cell ALL, the reported risk group did not match the calculated risk group allocation based on National Cancer Institute (NCI) criteria. Fluorescence in situ hybridization (FISH) and PCR tests were performed for 407 (19.2%) and 736 (34.8%) patients, respectively. Minimal residual disease (MRD) during induction was performed in 1,158 patients (54.7%). The median follow-up was 3.7 years. During induction, 191 patients died (9.1%), and 45 patients (2.1%) experienced induction failure. A total of 365 deaths (17.3%) occurred, including 174 deaths after remission. Six percent (176) of patients abandoned treatment. The 5-year event-free survival (EFS) was 58.9% ± 1.7% for B-cell ALL and 47.4% ± 5.9% for T-cell ALL, while the 5-year overall survival (OS) was 67.5% ± 1.6% for B-cell ALL and 54.3% ± 0.6% for T-cell ALL. The 5-year cumulative incidence of central nervous system (CNS) relapse was 5.5% ± 0.6%. For the whole cohort, significantly higher outcomes were seen for patients aged 1–10 years, with DNA index >0.9, with hyperdiploid ALL, and without substantial treatment modifications. In multivariable analyses, age and Day 15 MRD continued to have a significant effect on EFS.ConclusionOutcomes in this multi-institutional cohort describe poor outcomes, influenced by incomplete and inconsistent risk stratification, early toxic death, high on-treatment mortality, and high CNS relapse rate. Adopting comprehensive risk-stratification strategies, evidence-informed de-intensification for favorable-risk patients and optimized supportive care could improve outcomes.

show abstract

Section: Introductionmentioning

confidence: 99%

Evaluation of factors leading to poor outcomes for pediatric acute lymphoblastic leukemia in Mexico: a multi-institutional report of 2,116 patients

Moreira,

González-Ramella,

Echavarría Valenzuela

et al. 2023

Front. Oncol.

View full text Add to dashboard Cite

show abstract

“…Additionally, an increase of more than 30% improvement potential across all 10 sustainability indicators from 2013 to 2017 suggests the success of the WHO Framework for Action approach. The WHO Framework for Action model and its focus on long-term sustainability and a comprehensive approach to program implementation enabled us to systematically address commonly recognized elements to improving ALL outcomes in LMICs, including specialized training, 4 - 6 development of locally adapted treatment protocols, 19 providing supportive care and infection control, 9 , 17 , 18 , 28 , 29 ensuring funding for treatment, 6 , 14 , 22 , 25 supporting treatment adherence, and reducing financial toxicity toward affected patients' families through lodging and food subsidies. 6 - 8 , 14 …”

Section: Discussionmentioning

confidence: 99%

Childhood Leukemia Survival in the US-Mexico Border: Building Sustainable Leukemia Care Using Health Systems Strengthening Models

Aristizabal,

Rivera-Gomez,

Chang

et al. 2023

JCO Global Oncology

Self Cite

View full text Add to dashboard Cite

PURPOSE Pediatric leukemia outcomes are poor in most low- and middle-income countries (LMICs) and exacerbated by health care systems ill equipped to manage cancer. Effective leukemia management in LMICs involves curating epidemiologic data; providing health care workforce specialty training; developing evidence-based treatments and supportive care programs; safeguarding access to medications and equipment; providing patient and family psychosocial, financial, and nutritional support; partnering with nongovernmental organizations, and ensuring treatment adherence. METHODS In 2013, through a partnership between North-American and Mexican institutions, we used the WHO Framework for Action, a health systems strengthening model to implement a leukemia care sustainable program aimed at improving acute lymphoblastic leukemia (ALL) outcomes at a public hospital in Mexico. We prospectively assessed clinical features, risk classification, and survival outcomes in children with ALL at Hospital General-Tijuana from 2008 to 2012 (preimplementation) and from 2013 to 2017 (postimplementation). We also evaluated program sustainability indicators. RESULTS Our approach led to a fully-staffed leukemia service, sustainable training programs, evidence-based and data-driven projects to improve clinical outcomes, and funding for medications, supplies, and personnel through local partnerships. Preimplementation and postimplementation 5-year overall survival for the entire cohort of children with ALL, children with standard-risk ALL, and children with high-risk ALL improved from 59% to 65% ( P = .023), 73% to 100% ( P < .001), and 48% to 55% ( P = .031), respectively. All sustainability indicators improved between 2013 and 2017. CONCLUSION Using the health systems strengthening WHO Framework for Action model, we improved leukemia care and survival in a public hospital in Mexico across the US-Mexico border. We provide a model for the development of similar programs in LMICs to sustainably improve leukemia and other cancer outcomes.

show abstract

“…The time to antibiotics administration is considered a strong indicator of the quality of care provided in the cancer facility, and any initiative to decrease the mortality and morbidity in patients with FN should promptly address this. These initiatives should include skills training, staff education, up-to-date FN guideline implementation, and feedback on previous performance, as well as tackling more systemic issues for the cancer facilities in low- and middle-income countries, such as logistical issues or understaffed and overworked personnel [ 7 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and Management of Febrile Neutropenia in Pediatric Oncology Patients—A Systematic Review

Boeriu

Borda²,

Vulcanescu

et al. 2022

Diagnostics

View full text Add to dashboard Cite

Infectious diseases are associated with a high morbidity and mortality rate among pediatric cancer patients undergoing treatment or receiving a transplant. Neutropenia represents a potentially fatal complication of cancer treatment and is associated with a high risk of developing bacterial infections. Although febrile neutropenia (FN) can affect both adults and children, the latter has a higher chance of infections with an unknown origin. Prompt empiric broad-spectrum antibiotic administration is collectively considered the best therapeutic approach. This review aims to analyze the latest works from the literature regarding the therapeutic strategies, schemes, and approaches and the efficacy of these in pediatric febrile neutropenia. Following PRISMA guidelines, an advanced search on PubMed, Scopus, and Cochrane Library, using the keywords “febrile neutropenia”, “pediatric”, “cancer”, and “oncology”, was performed. A total of 197 articles were found to be eligible. After screening the abstracts and excluding unfit studies, 16 articles were analyzed. There were eight retrospective studies, five prospective studies, and two clinical trials. Altogether, these studies have described around 5000 episodes of FN. The median age of the participants was 7.6 years, and the underlying condition for most of them was acute leukemia. The infectious agent could only be determined in around one-fifth of cases, from which 90% were of bacterial origin. As such, empirical broad-spectrum antibiotics are used, with the most used treatment scheme comprising third- and fourth-generation cephalosporins and antipseudomonal penicillins. In order to improve the treatment strategies of FN episodes and to successfully de-escalate treatments toward narrower-spectrum antibiotics, hospitals and clinics should increase their efforts in identifying the underlying cause of FN episodes through blood culture urine culture and viral tests, wherever infrastructure enables it.

show abstract

The “Golden Hour”: a capacity-building initiative to decrease life-threating complications related to neutropenic fever in patients with hematologic malignancies in low- and middle-income countries

Cited by 7 publications

References 6 publications

Evaluation of factors leading to poor outcomes for pediatric acute lymphoblastic leukemia in Mexico: a multi-institutional report of 2,116 patients

Evaluation of factors leading to poor outcomes for pediatric acute lymphoblastic leukemia in Mexico: a multi-institutional report of 2,116 patients

Childhood Leukemia Survival in the US-Mexico Border: Building Sustainable Leukemia Care Using Health Systems Strengthening Models

Diagnosis and Management of Febrile Neutropenia in Pediatric Oncology Patients—A Systematic Review

Contact Info

Product

Resources

About