Treatment of Pediatric Cancer in Central America Impact of AHOPCA on - PowerPoint PPT Presentation

Treatment of Pediatric Cancer in Central America Impact of AHOPCA on Survival Raul C. Ribeiro, MD Department of Oncology Division of Leukemia Lymphoma St. Jude Children’s Research Hospital Cure 4 Kids

POGO

AHOPCA • Association of Central American Pediatric Hematologists/Oncologists • Begun at the Milan International School of Pediatric Hematology/Oncology in 1998 • Many shared projects: annual meetings, research projects, protocols, drug- purchasing consortium, etc.

1800 cases of pediatric cancer and 20 pediatric oncologists

Honduras: 168 ALL patients (1999-2002) Before During During Total Causes of Early Treatment induc. induc. contin. Failure n (%) n (%) n (%) n (%) Death (all causes) 35 (21) 5 (3) 15 (9) 15 (9) Infection or sepsis 19 (11) 1 10 8 Hemorrhage 6 (4) 1 3 2 Other causes* 10 (6) 3 3 4 Treatment abandoned 36 (21) 1 (0.6) 13 (8) 22 (13) *Tumor lysis syndrome, MTX toxicity, adrenal insufficiency, SVC syndrome

Rationale • Cure rates of most pediatric cancers have increased over the past 30 years in developed countries—70% • Survival rates in developing countries varies from 10% to 50% • Most nations will continue to improve their general health status • Mortality in children age <5 years is decreasing (Rate in El Salvador fell 3.9% per year, 1990- 2001)

Statement “The therapies available for pediatric cancer in economically advanced countries are truly life-saving and therefore must be considered a fundamental right of all affected children.” Tonogni, G. 2002

AHOPCA Highlights • Latin American nurse training program • Hematology/oncology fellowship program • AFINCA • Diagnosis: Immunophenotyping program and pathology training, referral of samples • Ongoing protocols (ALL, AML, APL, Hodgkin lymphoma, RMS, Wilms, RB) • Infrastructure improvement programs (New units in Guatemala and Honduras, satellite clinic in Honduras)

Hematology/Oncology Fellowship • 3-year program in Guatemala for Central America countries • Support of training of pediatric hematologists/ oncologists • Major problem is salary support after graduation

Diagnosis: Immunophenotyping Program Honduras Pediatric Oncology Bone Center marrow samples (overnight El Salvador shipping) Pediatric Worldwide Oncology Web Site Center Bone Flow Flow marrow cytometry cytometry samples data (file data (file (local transfer transfer Guatemala Flow Flow shipping) protocol) protocol) Pediatric Cytometry Cytometry Oncology Laboratory Laboratory Center (Guatemala) (St. Jude) Feedback, discussion (telephone, email, real-time computer connection to flow cytometer)

RECLUTAMI ENTO POR AÑO DE DI AGNÓSTI CO AÑO DE CR ES HO NI TOTAL DIAGNÓSTICO 2008 (5 meses) 18 11 26 24 79 2009 321 47 74 124 76 2010 286 50 76 88 72 2011 53 76 91 89 309 2012 314 49 81 112 72 2013 50 73 85 84 292 2014 302 41 61 127 73 2015 287 37 74 101 75 2016(10 meses) 8 20 26 19 73 TOTAL 353 546 780 584 2263

OUTCOME POR TRATAMI ENTO ADMI NI STRADO RS RI RA/RA+rtc TOTAL PRIMER EVENTO N % N % N % N % EN ESTUDIO 595 896 772 2263 12 24 38 74 FALLECIDO, EN INDUCCIÓN 2.0 2.7 4.9 3.3 12 13 19 47 ABANDONO, EN INDUCCIÓN 2.5 1.5 2.5 2.1 0 0 32 32 RESISTENTE 4.2 1.4 568 859 683 2110 EN CR AL FINAL DE LA INDUCCIÓN 95.5 95.9 88.5 93.2 41 69 50 160 ABANDONO, EN CR 6.9 7.7 6.5 7.1 118 235 229 582 RECAÍDA 19.8 26.2 29.7 25.7 54 143 150 347 En terapia 9.1 16.0 19.4 15.3 64 92 79 235 Fuera terapia 10.8 10.3 10.2 10.4 - Medula Ósea 72 155 160 387 61.0 66.0 69.9 66.5 - Extra-medular 27 65 52 144 22.9 27.7 22.7 24.7 - Combinado 18 15 16 49 15.3 6.4 7.0 8.4 - Desconocido 1 - 1 2 0.9 0.4 0.3 - - 1 1 SNM 0.1 0.0 9 37 30 76 FALLECIDO, EN CR 1.5 4.1 3.9 3.4 383 508 362 1253 VIVO, EN CCR 64.4 56.7 46.9 55.4 17 10 11 38 TRASLADO/PERDIDO AL SEG. 2.9 1.1 1.4 1.7

SLE N pts en riesgo=2263*/972 eventos ST N pts en riesgo=2263*/761eventos Años desde el diagnóstico %SLE ES N pts “at risk” %ST ES N pts “at risk” 1 79.3 0.9 1712 84.9 0.8 1829 2 67.8 1.0 1262 75.1 0.9 1398 3 58.6 1.1 887 69.3 1.0 1048 4 52.4 1.2 609 64.0 1.1 749 5 50.2 1.2 443 60.9 1.2 537 6 49.1 1.3 277 59.2 1.3 335 7 48.5 1.3 147 57.7 1.4 170 8 47.8 1.4 27 56.9 1.4 29

Años desde el Costa Rica N=353/100 El Salvador N=546/195 Honduras N=780/369 Nicaragua N=584/308 diagnóstico %EFS ES N %EFS ES N %EFS ES N %EFS ES N 1 93.8 1.3 329 85.6 1.5 447 73.7 1.6 546 71.9 1.9 390 2 87.1 1.8 269 75.0 1.9 330 62.4 1.8 391 56.4 2.1 272 3 77.0 2.4 204 65.4 2.2 235 53.8 1.9 257 47.0 2.2 191 4 67.1 2.8 145 60.5 2.4 172 47.5 2.1 167 42.5 2.3 125 5 65.6 2.9 111 57.6 2.5 119 44.4 2.2 111 41.0 2.3 102 6 65.6 2.9 78 54.3 2.8 59 43.1 2.2 66 41.0 2.3 74 7 65.6 2.9 44 54.3 2.8 21 42.2 2.4 38 39.9 2.4 44 8 65.6 2.9 18 NE NE 0 42.2 2.4 2 38.4 2.7 7

Años desde el RS N=595/195 eventos RI N=869/378 eventos RA/RA+rtc N=772/399 eventos diagnóstico %EFS ES N %EFS ES N %EFS ES N 1 85.5 1.5 495 81.4 1.3 692 71.9 1.6 525 2 78.2 1.7 403 68.6 1.6 501 58.6 1.8 358 3 69.2 2.0 282 59.1 1.8 356 49.4 2.0 249 4 64.7 2.2 207 53.3 1.9 245 41.5 2.1 157 5 63.3 2.2 157 50.3 2.0 177 39.4 2.1 109 6 61.0 2.4 102 50.0 2.0 107 38.5 2.1 68 7 59.6 2.5 65 49.5 2.0 50 38.5 2.1 32 8 59.6 2.5 12 47.6 2.7 7 38.5 2.1 8

9 años de reclutamiento 01/07/2007 hasta el 30/06/2016 Seguimiento actualizado en 16 de Enero 2017

Conclusions • Improved outcome in pediatric cancer in Central America is result of a multidisciplinary approach • Alliance of multiple partners allowed for relatively rapid progress • Cooperation and collaboration are essential for success