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Pediatric mature B-cell NHL, early referral and supportive care problems in a developing country
Felix Gaytan-Morales1, Francisco Alejo-Gonzalez2, Alfonso Reyes-Lopez3
1a Servicio de Oncología, Hospital Infantil de México, Dr. Federico Gómez. , Cuauhtémoc, México City , México.
Insights
Pediatric B-cell non-Hodgkin lymphoma (B-NHL) outcomes in Mexico show a need for improved care. Strategies focusing on supportive care and early referral are crucial for better survival rates in children with B-NHL.
Area of Science:
- Pediatric Oncology
- Hematology
- Cancer Research
Background:
- Mature B-cell non-Hodgkin lymphoma (B-NHL) is a significant pediatric cancer, accounting for over 50% of NHL cases in children and adolescents.
- A previous report indicated a 71% overall survival (OS) for lymphoma in Mexican pediatric and adolescent populations.
- This study aimed to analyze B-NHL characteristics and outcomes in Mexico to identify areas for healthcare improvement.
Purpose of the Study:
- To analyze the clinical characteristics and outcomes of pediatric B-cell non-Hodgkin lymphoma (B-NHL) in Mexico.
- To identify key areas for improvement in pediatric cancer care for B-NHL patients.
- To inform the development of strategies to enhance healthcare for children with B-NHL.
Main Methods:
- A retrospective study was conducted involving 166 pediatric patients diagnosed with B-cell NHL between January 1, 2000, and December 31, 2016.
- Data were collected from participating institutions across Mexico.
- Analysis focused on clinical characteristics and patient outcomes.
Main Results:
- Five-year event-free survival (EFS) was 63% for Burkitt lymphoma/B-cell lymphoblastic lymphoma (BL/BLL) and 80% for diffuse large B-cell lymphoma (DLBCL).
- Five-year progression-free survival (PFS) was 81% for BL/BLL and 91% for DLBCL.
- Five-year overall survival (OS) was 71% for BL/BLL and 83% for DLBCL.
Conclusions:
- A significant proportion of deaths (10.84% cumulative incidence) were due to acute treatment toxicity, with an early death rate of 7.23% (<30 days post-treatment).
- There is an urgent need for academic collaboration to develop strategies for improving pediatric cancer care, particularly for B-NHL.
- Recommended strategies include comprehensive supportive care, early referral, improved communication between pediatric and adult centers, and dedicated late-effects clinics.
Objective:
Mature B-cell non-Hodgkin lymphoma (B-NHL) comprises more than 50% of all non-Hodgkin lymphoma (NHL) in children and adolescents. An official report published by the Mexican National Center for the Control and Prevention of Cancer in the Pediatric and Adolescent Populations, reported a lymphoma OS of 71% (including all Hodgkin and NHL). The Mexican Association of Pediatric Oncology and Hematology conducted a retrospective study to analyze the clinical characteristics and outcomes of children with diagnosis of B-NHL in Mexico, in order to perceive the main areas of improvement in the health care.
Methods:
From 1 January 2000 to 31 December 2016, 166 pediatric patients were diagnosed with B-cell NHL at the participant institutions.
Results:
According to histology the outcomes were 5-year EFS 63%, for BL/BLL, and 80% DLBCL, (P = .051), 5-year PFS 81%, for BL/BLL, and 91% for DLBCL, (P = .126), and 5-year OS 71%, for BL/BLL, and 83% for DLBCL, (P = .095).
Discussion:
Overall, 18 patients died due to acute treatment toxicity, resulting in a cumulative incidence of toxic death of 10.84% and an early death rate of 7.23%, defined as <30 days after initial treatment. In conclusion, there is an urgent need to establish an academic collaboration to create strategies to improve pediatric cancer care according to our resources, especially in diseases with expected excellent prognosis as B-NHL. These strategies must include comprehensive supportive care, early referral, and the creation of easy communication between pediatric and adults centers as well as late-effects clinics.
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