Supervivencia y factores asociados a infiltración del Sistema Nervioso Central por Leucemia Linfoblástica Aguda, en SOLCA-Cuenca, período 2012 - 2016 - Survival and factors associated with infiltration of the Central Nervous System by Acute Lymphoblastic Leukemia, in SOLCA-Cuenca, period 2012 - 2016
DOI:
https://doi.org/10.29166/rfcmq.v49i2.6646Palabras clave:
Infiltración Leucémica, Leucemia-Linfoma Linfoblástico de Células Precursoras, Sistema Nervioso CentralResumen
Introducción: La infiltración leucémica del sistema nervioso central es un factor negativo en la supervivencia de pacientes con leucemia linfoblástica aguda.
Objetivo: Identificar factores de riesgo asociados con infiltración por leucemia linfoblástica aguda al sistema nervioso central al diagnóstico y determinar la supervivencia libre de enfermedad y supervivencia global, en niños con y sin infiltración al sistema nervioso central.
Material y métodos: Cohorte retrospectiva, pacientes entre 1 y 18 años, diagnosticados de LLA, mayo 2012 enero 2016, SOLCA-Cuenca, Ecuador. Variables dependientes: infiltración leucémica, supervivencia libre de enfermedad y supervivencia global. Variables independientes: edad, glóbulos blancos, plaquetas, deshidrogenasa láctica, día primera intratecal, inmunofenotipo, cromosoma Philadelphia, uso de anestesia general en el procedimiento y glóbulos rojos en líquido cefalorraquídeo
Resultados: 68 pacientes, 23 (33,8%) presentaron al diagnóstico infiltración leucémica al Sistema Nervioso Central. El análisis bivariado reveló que GB>10 000/μL, plaquetas <41 500/μL y DHL ≥610U/L tuvieron 3,05; 4,67 y 4,5 respectivamente mayor riesgo de infiltración (p<0,05). La supervivencia libre de enfermedad entre infiltrados y no infiltrados fue 52,6% (error típico (ET): 0,13) y 68,4% (ET: 0,08) respectivamente (p>0,05). La SG fue 60,9% (ET: 0,1) en los infiltrados y 72,5% (ET: 0,06) en los no infiltrados (p>0,05).
Conclusiones: Los factores de riesgo asociados a infiltración por Leucemia Linfoblástica Aguda al Sistema Nervioso Central fueron GB>10 000/μL, plaquetas <41 500/μL y deshidrogenasa láctica ≥610 U/L. La supervivencia libre de enfermedad y supervivencia global fue menor en los pacientes infiltrados que en no infiltrados.
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Bispo JAB, Pinheiro PS, Kobetz EK. Epidemiology and etiology of leukemia and lymphoma. Cold Spring Harb Perspect Med [Internet]. 2020[Cited May 6, 2024];10(6):a034819. Available from: https://doi.org/10.1101/cshperspect.a034819
Kato M. Pediatric acute lymphoblastic leukemia. 1.a ed. Singapore: Springer [Internet]. 2020 [Cited May6, 2024]. Available from: https://doi.org/10.1007/978-981-15-0548-5
Girard S, Fenneteau O, Mestrallet F, Troussard X, Lesesve JF. Recommandations pour l’analyse du liquide céphalorachidien au cours des leucémies aiguës. Annales de Biologie Clinique [Internet]. 2017[Cited May6, 2024];75(5):503-512. Available from: https://doi.org/10.1684/abc.2017.1250
Vadillo E, Dorantes-Acosta E, Pelayo R, Schnoor M. T cell acute lymphoblastic leukemia (T-ALL): New insights into the cellular origins and infiltration mechanisms common and unique among hematologic malignancies. Blood Rev [Internet]. 2018[Cited May6, 2024];32(1):36-51. Available from: https://doi.org/10.1016/j.blre.2017.08.006
Jin M, An Q, Xu S. Central nervous system disease in childhood acute lymphoblastic leukemia. Minerva Pediatr [Internet]. 2019[Cited May6, 2024];71(5):470-474. Available from: https://doi.org/10.23736/S0026-4946.16.04445-5
Asco Knowledge Conquers Cancer. Leukemia - acute lymphocytic - ALL: Statistics. [Internet]. 2023 [Cited Oct13, 2023]. Available from: https://www.cancer.net/cancer-types/leukemia-acute-lymphocytic-all/statistics
Bonaventure A, Harewood R, Stiller CA, Gatta G, Clavel J, Stefan DC, et al. Worldwide comparison of survival from childhood leukaemia for 1995-2009, by subtype, age, and sex (CONCORD-2): a population-based study of individual data for 89 828 children from 198 registries in 53 countries. Lancet Haematol [Internet]. 2017[Cited Oct13, 2023];4(5):e202-e217. Available from: https://doi.org/10.1016/S2352-3026(17)30052-2
Thastrup M, Marquart HV, Levinsen M, Grell K, Abrahamsson J, Albertsen BK, et al. Flow cytometric detection of leukemic blasts in cerebrospinal fluid predicts risk of relapse in childhood acute lymphoblastic leukemia: a Nordic Society of Pediatric Hematology and Oncology study. Leukemia [Internet]. 2020[Cited May 6, 2024];34(2):336-346. Available from: https://doi.org/10.1038/s41375-019-0570-1
Del Principe MI, Maurillo L, Buccisano F, Sconocchia G, Cefalo M, De Santis G, et al. Central nervous system involvement in adult acute lymphoblastic leukemia: diagnostic tools, prophylaxis, and therapy. Mediterr J Hematol Infect Dis. Leukemia [Internet]. 2014[Cited May 6, 2024];6(1): e2014075. Available from: https://doi.org/10.4084/MJHID.2014.075.
Deak D, Gorcea-Andronic N, Sas V, Teodorescu P, Constantinescu C, Iluta S, et al. A narrative review of central nervous system involvement in acute leukemias. Ann Transl Med [Internet]. 2021[Cited May 6, 2024];9(1):68. Available from: https://doi.org/10.21037/atm-20-3140
Thastrup M, Duguid A, Mirian C, Schmiegelow K, Halsey C. Central nervous system involvement in childhood acute lymphoblastic leukemia: challenges and solutions. Leukemia [Internet]. 2022[Cited May 6, 2024];36(12):2751-2768. Available from: https://doi.org/10.1038/s41375-022-01714-x
Stary J, Zimmermann M, Campbell M, Castillo L, Dibar E, Donska S, et al. Intensive chemotherapy for childhood acute lymphoblastic leukemia: Results of the randomized intercontinental trial ALL IC-BFM 2002. J Clin Oncol [Internet]. 2014[Cited May 6, 2024];32(3):174–84. Available from: https://doi.org/10.1200/JCO.2013.48.6522
Pui CH, Campana D, Pei D, Bowman WP, Sandlund JT, Kaste SC, et al. Treating childhood acute lymphoblastic leukemia without cranial irradiation. N Engl J Med [Internet]. 2009[Cited May 6, 2024];360(26):2730-41. Available from: https://doi.org/10.1056/NEJMoa0900386
Maidstone and Tunbridge Wells NHS Trust, Haematology and transfusion. Haematology reference ranges [Internet]. 2020 [Cited Oct13, 2023]. Available from: https://www.mtw.nhs.uk/gps/pathology/haematology-and-transfusion/
Lazarus HM, Richards SM, Chopra R, Litzow MR, Burnett AK, Wiernik PH, et al. Central nervous system involvement in adult acute lymphoblastic leukemia at diagnosis: results from the international ALL trial MRC UKALL XII/ECOG E2993. Blood [Internet]. 2006[Cited Oct13, 2023];108(2):465-72. Available from: https://doi.org/10.1182/blood-2005-11-4666
Pritchard-Jones K, Pieters R, Reaman GH, Hjorth L, Downie P, Calaminus G, et al. Sustaining innovation and improvement in the treatment of childhood cancer: lessons from high-income countries. Lancet Oncol [Internet]. 2013[Cited Oct13, 2023];14(3):e95-e103. Available from: https://doi.org/10.1016/S1470-2045(13)70010-X
Pui CH, Thiel E. Central nervous system disease in hematologic malignancies: historical perspective and practical applications. Semin Oncol [Internet]. 2009[Cited Oct13, 2023];36(4 Suppl 2):S2-S16. Available from: https://doi.org/10.1053/j.seminoncol.2009.05.002
Howard SC, Gajjar AJ, Cheng C, Kritchevsky SB, Somes GW, Harrison PL, et al. Risk factors for traumatic and bloody lumbar puncture in children with acute lymphoblastic leukemia. JAMA [Internet]. 2002[Cited Oct13, 2023];288(16):2001-7. Available from: https://doi.org/10.1001/jama.288.16.2001
Lustosa DW, de Almeida FV, Cavalcante FH, de Oliveira MV. Acute lymphoblastic leukemia in children and adolescents: prognostic factors and analysis of survival. Rev Bras Hematol Hemoter [Internet]. 2015[Cited Oct13, 2023];37(4):223-9. Available from: https://doi.org/10.1016/j.bjhh.2015.03.009
Pui CH, Evans WE. Treatment of acute lymphoblastic leukemia. N Engl J Med. [Internet]. 2006[Cited Oct13, 2023];354(2):166-78. Available from: https://www.nejm.org/doi/10.1056/NEJMra052603
Pui CH, Pei D, Campana D, Bowman WP, Sandlund JT, Kaste SC, et al. Improved prognosis for older adolescents with acute lymphoblastic leukemia. J Clin Oncol [Internet]. 2011[Cited Oct13, 2023];29(4):386-91. Available from: https://doi.org/10.1200/JCO.2010.32.0325
Arshad U, Jabbar N, Mansoor N, Haider M, Butt Z, Nadeem K. Central nervous system involvement in childhood acute lymphoblastic leukemia: An analysis of day-one versus day-eight lumbar punctures in remission induction therapy. Cureus [Internet]. 2021[Cited Oct13, 2023];13(1):e12464. Available from: https://doi.org/10.7759/cureus.12464
Kornberg A, Polliack A. Serum lactic dehydrogenase (LDH) levels in acute leukemia: marked elevations in lymphoblastic leukemia. Blood [Internet]. 1980[Cited Oct13, 2023];56(3):351-5. Available from: https://doi.org/10.1182/blood.V56.3.351.351
Kong SG, Seo JH, Jun SE, Lee BK, Lim YT. Childhood acute lymphoblastic leukemia with hyperleukocytosis at presentation. Blood Res [Internet]. 2014[Cited Oct13, 2023];49(1):29-35. Available from: https://doi.org/10.5045/br.2014.49.1.29
Hasegawa D, Manabe A, Ohara A, Kikuchi A, Koh K, Kiyokawa N, et al.
The utility of performing the initial lumbar puncture on day 8 in remission induction therapy for childhood acute lymphoblastic leukemia: TCCSG L99-15 study. Pediatr Blood Cancer [Internet]. 2012 [Cited Oct13, 2023];58(1):23-30. Available from: https://doi.org/10.1002/pbc.22965
Brown AL, de Smith AJ, Gant VU, Yang W, Scheurer ME, Walsh KM, et al. Inherited genetic susceptibility to acute lymphoblastic leukemia in Down syndrome. Blood [Internet]. 2019[Cited Oct13, 2023];134(15):1227-37. Available from: https://doi.org/10.1182/blood.2018890764
Conter V, Bartram CR, Valsecchi MG, Schrauder A, Panzer-Grümayer R, Möricke A, et al. Molecular response to treatment redefines all prognostic factors in children and adolescents with B-cell precursor acute lymphoblastic leukemia: results in 3184 patients of the AIEOP-BFM ALL 2000 study. Blood [Internet]. 2010[Cited Oct13, 2023];115(16):3206-14. Available from: https://doi.org/10.1182/blood-2009-10-248146
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Derechos de autor 2024 Enmanuel Guerrero Quiroz, Andrea Bastidas Sánchez, Ximena Mejía Buri, Fary Martínez Reyes
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.
