Are there regional variations in the presentation of childhood leukemia?

Introduction: Treatment of childhood acute lymphoblastic leukemia (ALL) is basedon risk stratification. This study aimed to assess the agreement between risk groupclassifications in the different childhood ALL treatment protocols used in a referralhospital in southern Brazil.Methods: We retrospectively reviewed the medical records of patients aged 1 to18 years with B-cell ALL treated at a hospital from January 2013 to April 2017. Agreementbetween risk classifications was assessed by the kappa coefficient.Results: Seventy-five patients were analyzed. There was poor agreement betweenrisk stratification by GBTLI 2009 and BFM 95 protocols (kappa=0.22; p = 0.003) andby GBTLI 2009 and IC-BFM 2002 protocols (kappa=0.24; p = 0.002). Risk groupdistribution was 13.3% for low risk, 32.0% for intermediate risk, and 54.7% for highrisk based on stratification by the GBTLI 2009 protocol, and 28.0% for low risk, 42.7%for intermediate risk, and 29.3% for high risk based on stratification by the IC-BFM2002 protocol. Overall survival was 68.6%.Conclusion: This study provides numerous points to ponder about the treatmentof leukemia in Brazil. The percentage of patients classified as high risk in oursample was higher than that reported in the international literature. This difference,however, had no impact on overall survival, which was shorter than that reportedin the international literature

Are there regional variations in the presentation of childhood leukemia?

Introduction: Treatment of childhood acute lymphoblastic leukemia (ALL) is based on risk stratification. This study aimed to assess the agreement between risk group classifications in the different childhood ALL treatment protocols used in a referral hospital in southern Brazil. Methods: We retrospectively reviewed the medical records of patients aged 1 to 18 years with B-cell ALL treated at a hospital from January 2013 to April 2017. Agreement between risk classifications was assessed by the kappa coefficient. Results: Seventy-five patients were analyzed. There was poor agreement between risk stratification by GBTLI 2009 and BFM 95 protocols (kappa=0.22; p = 0.003) and by GBTLI 2009 and IC-BFM 2002 protocols (kappa=0.24; p = 0.002). Risk group distribution was 13.3% for low risk, 32.0% for intermediate risk, and 54.7% for high risk based on stratification by the GBTLI 2009 protocol, and 28.0% for low risk, 42.7% for intermediate risk, and 29.3% for high risk based on stratification by the IC-BFM 2002 protocol. Overall survival was 68.6%. Conclusion: This study provides numerous points to ponder about the treatment of leukemia in Brazil. The percentage of patients classified as high risk in our sample was higher than that reported in the international literature. This difference, however, had no impact on overall survival, which was shorter than that reported in the international literature

Epidemiological evaluation and survival of children with acute myeloid leukemia

Objective: This study aims to describe the epidemiological characteristics and survival rates of children with acute myeloid leukemia treated in hospitals in southern Brazil and compare them with international data. Methods: A multicenter cohort study was conducted with retrospective data collection of all new patients with acute myeloid leukemia under 18 treated at five referral centers in pediatric hematology-oncology in southern Brazil between January 2005 and December 2015. Results: Of the 149 patients with acute myeloid leukemia, 63.0% (n = 94) were male. The median age at diagnosis was 10.5 years (range 0-18 years) and 40.3% (n = 60) had a white blood cell count below 50,000/mm2. The most common Franco-American-British (FAB) subtype was M3 (n = 43, 28.9%). Nine (6.0%) patients had central nervous system disease. In M3 patients, overall survival (OS) was 69.2% and 3-year event-free survival was 67.7%; in non-M3 patients, these rates were 45.3% and 36.7%, respectively. In non-M3 patients, OS was significantly different between transplanted (61.8%) and non-transplanted (38.2%) patients (p = 0.031). Conclusions: These results show a higher prevalence of the Franco-American-British M3 subtype than that reported in the international literature, as well as a decreased OS compared with that of developed countries. Further multicenter Brazilian studies with a larger sample size are encouraged to better understand the characteristics of acute myeloid leukemia, and to improve the treatment and prognosis in this population

Telomere length in healthy newborns is not affected by adverse intrauterine environments

Different intrauterine exposures are associated with different metabolic profiles leading to growth and development characteristics in children and also relate to health and disease patterns in adult life. The objective of this work was to evaluate the impact of four different intrauterine environments on the telomere length of newborns. This is a longitudinal observational study using a convenience sample of 222 mothers and their term newborns (>37 weeks of gestational age) from hospitals in Porto Alegre, Rio Grande do Sul (Brazil), from September 2011 to January 2016. Sample was divided into four groups: pregnant women with Gestational Diabetes Mellitus (DM) (n=38), smoking pregnant women (TOBACCO) (n=52), mothers with small-for-gestational age (SGA) children due to idiopathic intrauterine growth restriction (n=33), and a control group (n=99). Maternal and newborn genomic DNA were obtained from epithelial mucosal cells. Telomere length was assessed by qPCR, with the calculation of the telomere and single copy gene (T/S ratio). In this sample, there was no significant difference in telomere length between groups (p>0.05). There was also no association between childbirth weight and telomere length in children (p>0.05). For term newborns different intrauterine environments seems not to influence telomere length at birth

Are there regional variations in the presentation of childhood leukemia?

Introduction: Treatment of childhood acute lymphoblastic leukemia (ALL) is basedon risk stratification. This study aimed to assess the agreement between risk groupclassifications in the different childhood ALL treatment protocols used in a referralhospital in southern Brazil.Methods: We retrospectively reviewed the medical records of patients aged 1 to18 years with B-cell ALL treated at a hospital from January 2013 to April 2017. Agreementbetween risk classifications was assessed by the kappa coefficient.Results: Seventy-five patients were analyzed. There was poor agreement betweenrisk stratification by GBTLI 2009 and BFM 95 protocols (kappa=0.22; p = 0.003) andby GBTLI 2009 and IC-BFM 2002 protocols (kappa=0.24; p = 0.002). Risk groupdistribution was 13.3% for low risk, 32.0% for intermediate risk, and 54.7% for highrisk based on stratification by the GBTLI 2009 protocol, and 28.0% for low risk, 42.7%for intermediate risk, and 29.3% for high risk based on stratification by the IC-BFM2002 protocol. Overall survival was 68.6%.Conclusion: This study provides numerous points to ponder about the treatmentof leukemia in Brazil. The percentage of patients classified as high risk in oursample was higher than that reported in the international literature. This difference,however, had no impact on overall survival, which was shorter than that reportedin the international literature