Protocol-based treatment for children with cancer in low income countries in Latin America a report on the recent meetings of the Monza International School of Pediatric Hematology/Oncology (MISPHO) - PART II

Scott Howard, Roberta Ortiz, Luis Fulgencio Baez, Ricardo Cabanas, José Barrantes, Ligia Fu, Armando Peña, Angélica Samudio, Martha Vizcaino, Carlos Rodríguez-Galindo, Ronald D. Barr, Valentino Conter, Andrea Biondi, Giuseppe Masera

Research output: Contribution to journalArticle

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Abstract

Pediatric cancer programs in low-income countries (LIC) can improve outcomes. However, treatment must be tailored to the patient's living conditions and the availability of supportive care. In some cases, a more intense regimen will decrease survival since the increase in death from toxicity may exceed any decrease in relapse. Attempts to practice evidence-based pediatric oncology are thwarted by the lack of evidence derived from local experience in LIC to determine optimal therapy. This report summarizes treatment regimens used by pediatric oncologists from 15 countries of the Caribbean, Central and South America who participate in the Monza International School of Pediatric Hematology/Oncology (MISPHO). Patients with hepatoblastoma, Wilms tumor, and histiocytosis treated on unmodified published protocols had outcomes comparable to those in high-income countries (HIC). Those with rhabdomyosarcoma, osteosarcoma, Hodgkin lymphoma, and acute myeloid leukemia treated with unmodified regimens had event-free survival estimates 10%-20% lower than those reported in HIC due to higher rates of toxic death, abandonment of therapy, and relapse. Treatment of retinoblastoma is complicated by advanced stages and extraocular disease at diagnosis; improved outcomes depend on education of pediatricians and the public to recognize early signs of this disease. Use of unmodified protocols for Burkitt lymphoma and acute lymphoblastic leukemia have been associated with unacceptable toxicity in LIC, so MISPHO centers have modified published regimens by giving lower doses of methotrexate and reducing use of anthracyclines. Despite the use of all-trans-retinoic acid during induction for acute promyelocytic leukemia, the incidence of fatal hemorrhage remains unacceptably high.

Original languageEnglish (US)
Pages (from-to)486-490
Number of pages5
JournalPediatric Blood and Cancer
Volume48
Issue number4
DOIs
StatePublished - Jan 1 2007

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Latin America
Hematology
Clinical Protocols
Pediatrics
Neoplasms
Histiocytosis
Hepatoblastoma
Therapeutics
Central America
Recurrence
Acute Promyelocytic Leukemia
Burkitt Lymphoma
Wilms Tumor
Rhabdomyosarcoma
Retinoblastoma
South America
Evidence-Based Practice
Poisons
Anthracyclines
Social Conditions

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology

Cite this

Protocol-based treatment for children with cancer in low income countries in Latin America a report on the recent meetings of the Monza International School of Pediatric Hematology/Oncology (MISPHO) - PART II. / Howard, Scott; Ortiz, Roberta; Baez, Luis Fulgencio; Cabanas, Ricardo; Barrantes, José; Fu, Ligia; Peña, Armando; Samudio, Angélica; Vizcaino, Martha; Rodríguez-Galindo, Carlos; Barr, Ronald D.; Conter, Valentino; Biondi, Andrea; Masera, Giuseppe.

In: Pediatric Blood and Cancer, Vol. 48, No. 4, 01.01.2007, p. 486-490.

Research output: Contribution to journalArticle

Howard, S, Ortiz, R, Baez, LF, Cabanas, R, Barrantes, J, Fu, L, Peña, A, Samudio, A, Vizcaino, M, Rodríguez-Galindo, C, Barr, RD, Conter, V, Biondi, A & Masera, G 2007, 'Protocol-based treatment for children with cancer in low income countries in Latin America a report on the recent meetings of the Monza International School of Pediatric Hematology/Oncology (MISPHO) - PART II', Pediatric Blood and Cancer, vol. 48, no. 4, pp. 486-490. https://doi.org/10.1002/pbc.20989
Howard, Scott ; Ortiz, Roberta ; Baez, Luis Fulgencio ; Cabanas, Ricardo ; Barrantes, José ; Fu, Ligia ; Peña, Armando ; Samudio, Angélica ; Vizcaino, Martha ; Rodríguez-Galindo, Carlos ; Barr, Ronald D. ; Conter, Valentino ; Biondi, Andrea ; Masera, Giuseppe. / Protocol-based treatment for children with cancer in low income countries in Latin America a report on the recent meetings of the Monza International School of Pediatric Hematology/Oncology (MISPHO) - PART II. In: Pediatric Blood and Cancer. 2007 ; Vol. 48, No. 4. pp. 486-490.
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