Publications by authors named "Marta Zapata-Tarrés"

24 Publications

  • Page 1 of 1

Does the Human Development Index relate with acute lymphoblastic leukemia incidence?

Bol Med Hosp Infant Mex 2021 Jan 26. Epub 2021 Jan 26.

Division of Hematology/Oncology. Instituto Nacional de Pediatría, Mexico City, Mexico.

Background: The association between childhood cancer and socioeconomic status has been widely studied. However, none of the results are conclusive. This study aimed to analyze the association between the Human Development Index (HDI) and the acute lymphoblastic leukemia (ALL) incidence in children under the Popular Medical Insurance Care.

Methods: We conducted an observational, descriptive, and population-based study covering 55% of the Mexican population (58 million).

Results: The most impoverished states were located in the south east region of Mexico, while the north was more homogeneous, with HDIs varying between 0.73 and 0.79. Our findings emphasize that the metropolitan area of Mexico City and the State of Nuevo Leon have the highest levels of HDI. Regions were graded from I to IV according to their HDIs in ascending order. The HDIs varied from 0.667 to 0.830/100,000 children/year, with a national average of 0.746. The leukemia incidence for regions I, II, III, and IV was 6.12, 6.53, 4.96, and 9.95. An analysis of ALL incidence in Mexico showed significant differences for region IV in comparison with the other regions based on the HDI values (p = 0.0001).

Conclusions: Further in-depth studies, including the economic aspects of the different geographic regions and their ethnographic characteristics, would give a more comprehensive panorama.
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http://dx.doi.org/10.24875/BMHIM.20000043DOI Listing
January 2021

[Dolor óseo generalizado e hipercalcemia en un lactante mayor como síntoma inicial de linfoma linfoblástico de células B].

Bol Med Hosp Infant Mex 2020 Nov 23. Epub 2020 Nov 23.

Servicio de Oncología Pediátrica, Instituto Nacional de Pediatría, Ciudad de México, México.

Introducción: Los linfomas no Hodgkin son neoplasias heterogéneas derivadas de las células linfohematopoyéticas. Es raro que se presenten antes de los 2 años de edad y la prevalencia es mayor en el sexo masculino. Caso clínico: Paciente de sexo masculino de 1 año y 11 meses que debutó con dolor en miembros inferiores y superiores, claudicación intermitente, deformidad ósea e hipotonía generalizada, por lo que se sospechaba artritis juvenil. Se trató con antiinflamatorios no esteroideos. Al no haber mejoría, ingresó a otro hospital con adenopatías y nodulaciones en la región escrotal y braquial, y hepatomegalia, por lo que se presumió la activación precoz de la pubertad con evidencia de hipercalcemia. Los estudios radiológicos indicaron una posible displasia ósea. Sin embargo, la tomografía por emisión de positrones detectó zonas compatibles con un proceso maligno. Se diagnosticó linfoma de precursores B. La hipercalcemia es una alteración metabólica que, en presencia de cáncer, se considera un síndrome paraneoplásico. Es un dato clínico excepcional que se puede observar en niños con leucemia linfoblástica aguda. Conclusiones: El dolor óseo en la edad pediátrica amerita una exploración física minuciosa para realizar un diagnóstico oportuno del cáncer infantil y mejorar el pronóstico del paciente.
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http://dx.doi.org/10.24875/BMHIM.20000103DOI Listing
November 2020

Aberrant immunophenotypes in acute lymphoblastic leukemia.

Bol Med Hosp Infant Mex 2020 ;77(6):287-292

Departamento de Oncología, Instituto Nacional de Pediatría. Mexico City, Mexico.

Acute lymphoblastic leukemia (ALL) is the most prevalent hematologic neoplasia worldwide. To classify leukemia, we analyzed the immunophenotypic characteristics in the neoplastic cells obtained with antibodies by cell flow cytometry or immunohistochemistry. The aberrant immunophenotypes are antigen expression patterns that differ from the normal hematopoietic maturation process, which can include some different lineage antigens such as myeloid antigens in ALL or asynchronous expression of antigens. These aberrant immunophenotypes have been studied as prognostic factors and residual disease markers. In this review, some aspects of aberrant immunophenotypes are addressed, including definition, epidemiology, and potential uses.
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http://dx.doi.org/10.24875/BMHIM.20000171DOI Listing
January 2020

Patient and health service factors associated with delays in cancer treatment for children without social security in Mexico.

Pediatr Blood Cancer 2020 09 15;67(9):e28331. Epub 2020 Jul 15.

Division of Social Protection and Health. Jamaica Country Office, Interamerican Development Bank, Kingston, Jamaica.

Background: The objective was to investigate factors associated with patient-related timing (PRT) to seek healthcare and health service-related timing (HSRT) to diagnose cancer and provide treatment to children without social security in Mexico.

Procedure: A cross-sectional survey was conducted in 13 Ministry of Health hospitals in the states of Chihuahua, Jalisco, Mexico City, Morelos, Oaxaca, Puebla, Queretaro, State of Mexico, and Tlaxcala. Study participants were parents of recently diagnosed pediatric cancer patients (≤ 17 years of age). Three groups of factors were investigated: (1) patients (child and parent characteristics); (2) healthcare providers (HCPs) (first-contact HCP, institution, perceptions of barriers to healthcare, etc.); and (3) disease factors (cancer type/site, stage/risk at diagnosis). PRT and HSRT-associated factors were identified using multiple negative binomial regressions.

Results: The study included 265 children; 49% sought care when symptoms first appeared. The median PRT was seven days, and the median HSRT was 40 days. Parents' perceptions of long wait times for appointments were associated with longer PRT and HSRT. Residing in the lowest or highest socioeconomic regions and persistent or worsening symptoms increased the probability of longer PRT. Older patient age, HCP requests for imaging tests or prescription for steroids, a higher number of doctors consulted, having a urinary tract cancer, and having an advanced stage or high-risk cancer increased the probability of longer HSRT.

Conclusion: Strategies to shorten lag time from symptom onset to diagnosis and treatment are urgently needed for childhood cancers in Mexico.
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http://dx.doi.org/10.1002/pbc.28331DOI Listing
September 2020

Analysis of gene allelic variants can predict ifosfamide toxicity in Mexican paediatric patients.

Biomarkers 2020 Jun 30;25(4):331-340. Epub 2020 Apr 30.

Department of Biomedical Oncology Laboratory, National Institute of Respiratory Diseases, Mexico City, Mexico.

Ifosfamide (IFA) is an effective antineoplastic for solid tumours in children, although it is associated with high levels of systemic toxicity and causes death in some cases. The aim of this study was to determine whether the presence of certain allelic variants of genes , , and increases the risk of toxicity in children with solid tumours treated with ifosfamide. A total of 131 DNA samples were genotyped by real-time polymerase chain reaction (RT-PCR) using TaqMan probes. Toxicity was assessed using WHO criteria, and survival analysis was performed using Kaplan-Meier curves. The rs3745274 allelic variant in was associated with haematological toxicity, affecting neutrophils; variant rs2740574 was also associated with toxicity, affecting both leukocytes and neutrophils. Additionally, the gene variant rs776746 was found to affect haemoglobin. Our results show that allelic variants rs3745274 (, rs2740574 ( and rs776746 ( increase the risk for high haematological toxicity. 068/2013.
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http://dx.doi.org/10.1080/1354750X.2020.1754913DOI Listing
June 2020

Safety and efficacy of step-down to oral outpatient treatment versus inpatient antimicrobial treatment in pediatric cancer patients with febrile neutropenia: A noninferiority multicenter randomized clinical trial.

Pediatr Blood Cancer 2020 06 20;67(6):e28251. Epub 2020 Mar 20.

Oncology Department, Instituto Nacional de Pediatría, Mexico City, Mexico.

Background: It has been suggested that low-risk febrile neutropenia (FN) episodes can be treated in a step-down manner in the outpatient setting. This recommendation has been limited to implementation in middle-income countries due to concerns about infrastructure and lack of trained personnel. We aimed to determine whether early step-down to oral antimicrobial outpatient treatment is not inferior in safety and efficacy to inpatient intravenous treatment in children with low-risk FN.

Procedure: A noninferiority randomized controlled clinical trial was conducted in three hospitals in Mexico City. Low-risk FN was identified in children younger than 18 years. After 48 to 72 hours of intravenous treatment, children were randomly allocated to receive outpatient oral treatment (experimental arm, cefixime) or to continue inpatient treatment (standard of care, cefepime). Daily monitoring was performed until neutropenia resolution. The presence of any unfavorable clinical outcome was the endpoint of interest. We performed a noninferiority test for comparison of proportions.

Results: We identified 1237 FN episodes; 117 cases were randomized: 60 to the outpatient group and 57 for continued inpatient treatment. Of the FN episodes, 100% in the outpatient group and 93% in the inpatient group had a favorable outcome (P < 0.001). The mean duration of antibiotics was 4.1 days (SD 2.5; 95% CI, 3.4-4.8 days) in the outpatient group and 4.4 days (SD 2.5; 95% CI, 3.7-5.0 days) in the inpatient group (P = 0.70).

Conclusions: In our population, step-down oral outpatient treatment of low-risk FN was as safe and effective as inpatient intravenous treatment. Clinical Trials Identifier: NCT04000711.
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http://dx.doi.org/10.1002/pbc.28251DOI Listing
June 2020

Access to paediatric cancer care treatment in Mexico: responding to health system challenges and opportunities.

Health Policy Plan 2020 Apr;35(3):291-301

Division of Social Protection and Health, Jamaica Country Office, Inter-American Development Bank, Montrose Road 6, Kingston, Jamaica.

In Mexico, paediatric cancer is the leading cause of death for children aged 0-18 years. This study analyses the main challenges for paediatric cancer care from the perspective of three key health systems functions: stewardship, financing and service delivery. The study used a mixed methods approach comprised of: (1) a scoping literature review, (2) an analysis of 2008-18 expenditures on paediatric cancer by the Fund for Protection against Catastrophic Expenditures (FPGC) of Seguro Popular and (3) a nation-wide survey of the supply capacity of 59 Ministry of Health (MoH) and 39 Mexican Institute of Social Security (IMSS) hospitals engaged in paediatric cancer care. The study found that while Mexico has made substantial progress towards universal health coverage (UHC) for paediatric cancer treatment, serious gaps persist. FPGC funds for paediatric cancer increased from 2008 to 2011 to reach US$36 million and then declined to US$13.6 million in 2018, along with the number of covered cases. The distribution of health professionals and paediatric oncology infrastructure is uneven between MoH and IMSS hospitals and across Mexican regions. Both institutions share common barriers for continuous and co-ordinated health care and lack monitoring activities that cripple their capacity to apply uniform standards for high-quality cancer care. In conclusion, achieving universal and effective coverage of paediatric cancer treatment is a critical component of UHC for Mexico. This requires periodic and ongoing assessment of health system performance specific to paediatric cancer to identify gaps and propose strategies for continued investment and improvement of access to care and health outcomes for this important cause of premature mortality.
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http://dx.doi.org/10.1093/heapol/czz164DOI Listing
April 2020

National Clinical Practice Guidelines for the management of non-small cell lung cancer in early, locally advanced and metastatic stages. Extended version.

Authors:
Feliciano Barrón-Barrón Enrique Guzmán-De Alba Jorge Alatorre-Alexander Fernando Aldaco-Sarvider Yolanda Bautista-Aragón Mónica Blake-Cerda Yazmín Carolina Blanco-Vázquez Saúl Campos-Gómez José Francisco Corona-Cruz Marco Antonio Iñiguez-García Francisco Javier Lozano-Ruiz Federico Maldonado-Magos Dolores de la Mata-Moya Luis Manuel Martínez-Barrera Rubí Ramos-Prudencio Jerónimo Rodríguez-Cid Samuel Rivera-Rivera Raúl Rogelio Trejo-Rosales Marco Rodrigo Aguilar-Ortíz Horacio Astudillo-de la Vega Luis Javier Barajas-Figueroa Nimbe Barroso-Quiroga Andrés Blanco-Salazar Graciano Castillo-Ortega Luis Manuel Domínguez-Parra María Isabel Enriquez-Aceves Armando Fernández-Orozco Marco Antonio Figueroa-Morales León Green-Schneewiss Jorge Alejandro González-Garay Rogelio González Ramírez-Benfield Alberto Guadarrama-Orozco Jorge Guerrero-Ixtlahuac David Hernández-Barajas Raymundo Hernández-Montes de Oca Javier Kelly-García Miguel Lázaro-León Fernando Silva-Bravo Jóse Luis Tellez-Becerra Eleazar Omar Macedo-Pérez Gibert Maza-Ramos José Luis Mayorga-Butrón Bertha Beatriz Montaño-Velázquez Karina Murillo-Medina Salvador Narváez-Fernández Francisco Javier Ochoa-Carrillo Guillermo Olivares-Beltrán Carlos Olivares-Torres Mario Ponce de León-Castillo Mario Alberto Ponce-Viveros Jaime Ernesto Rubio-Gutiérrez Julia Angelina Sáenz-Frías Jorge Alberto Silva-Vivas Patricio Santillán-Doherty Juan José Soto-Ávila Vinicio Toledo-Buenrostro Benito Vargas-Abrego Liliana Velasco-Hidalgo Marta Margarita Zapata-Tarres Gregorio Quintero-Beuló Oscar Arrieta

Salud Publica Mex 2019 May-Jun;61(3):359-414

Instituto Nacional de Cancerología. Ciudad de México, México.

Objective: Lung cancer is one the leading causes of mortality worldwide. Symptomatic manifestations of the disease generally occur in the advanced-stage setting, and therefore an important number of patients have advanced or metastatic disease by the time they are diagnosed. This situation contributes to a poor prognosis in the treatment of lung cancer. Evidencebased clinical recommendations are of great value to support decision-making for daily practice, and thus improving health care quality and patient outcomes.

Materials And Methods: This document was an initiative of the Mexican Society of Oncology (SMEO) in collaboration with Mexican Center of Clinical Excellence (Cenetec) according to Interna- tional Standards. Such standards included those described by the IOM, NICE, SIGN and GI-N. An interdisciplinary Guideline Development Group (GDG) was put together which included medical oncologists, surgical oncologistsc, radiation therapists, and methodologists with expertise in critical appraisal, sys- tematic reviews and clinical practice guidelines development.

Results: 62 clinical questions were agreed among members of the GDG. With the evidence identified from systematic reviews, the GDG developed clinical recommendations using a Modified Delphi Panel technique. Patients' representatives validated them.

Conclusions: These Clinical Practice Guideline aims to support the shared decision-making process for patients with different stages of non-small cell lung cancer. Our goal is to improve health-care quality on these patients.
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http://dx.doi.org/10.21149/9916DOI Listing
January 2020

Variants in ARID5B gene are associated with the development of acute lymphoblastic leukemia in Mexican children.

Ann Hematol 2019 Oct 21;98(10):2379-2388. Epub 2019 Jun 21.

Laboratorio de Genética y Cáncer, Instituto Nacional de Pediatría, Insurgentes Sur 3700-C, Colonia Insurgentes Cuicuilco, C.P. 04530, Mexico City, Mexico.

A high impact of ARID5B SNPs on acute lymphoblastic leukemia (ALL) susceptibility has been described in Hispanic children; therefore, it is relevant to know if they influence the high incidence of childhood-ALL in Mexicans. Seven SNPs (rs10821936, rs10994982, rs7089424, rs2393732, rs2393782, rs2893881, rs4948488) of ARID5B were analyzed in 384 controls and 298 ALL children using genomic DNA and TaqMan probes. The SNPs were analyzed for deviation of Hardy-Weinberg equilibrium; Fisher's exact test was used to compare the genotypic and allelic frequencies between controls and patients. The association between SNPs and ALL susceptibility was calculated, and haplotype and ancestry analyses were conducted. All SNPs were associated with ALL, pre-B ALL, and hyperdiploid-ALL susceptibility (p < 0.05). No association with T-ALL and gene fusions was found (p > 0.05). The seven SNPs were associated with risk of pre-B ALL in younger children; however, rs2393732, rs2393782, rs2893881, and rs4948488 were not associated with susceptibility in older children and adolescents. The CAG haplotype (rs10821936, rs10994982, rs7089424) was strongly associated with ALL risk in our population (p < 0.00001). The frequency of all risk alleles in our ALL, pre-B, and hyperdiploid-ALL patients was higher than that in Hispanic children reported. This is the first report showing the association between rs2393732, rs2393782, and rs4948488 with pre-B hyperdiploid-ALL children. The G allele at rs2893881 confers major risk for pre-B hyperdiploid-ALL in Mexican (OR, 2.29) than in Hispanic children (OR, 1.71). The genetic background of our population could influence the susceptibility to ALL and explain its high incidence in Mexico.
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http://dx.doi.org/10.1007/s00277-019-03730-xDOI Listing
October 2019

Feeding difficulties and eating disorders in pediatric patients with cancer.

Bol Med Hosp Infant Mex 2019 ;76(3):113-119

Subdirección de Hematología/Oncología Instituto Nacional de Pediatría, Mexico City, Mexico.

Background: Feeding difficulties and disorders are a common problem in the pediatric population, which involve a series of deficient behaviors about nutrition processes that can adversely affect psychomotor, psychosocial, and physical development of children. This study aimed to describe the frequency of feeding difficulties or disorders in pediatric patients with cancer.

Methods: A prospective study which included 125 children from 1-19 years treated at the Department of Oncology of the Instituto Nacional de Pediatría, Mexico City, was conducted. The diagnosis of eating disorders and feeding difficulties was determined during the first 48 h since admission, and the age of the patient influenced the type of disorder and feeding difficulties.

Results: Children older than 11 years presented more frequently an intense resistance of feeding because of discomfort pain (fear of feeding) than younger children (11.4 ± 4.7 vs. 7.4 ± 4.9, p ≤ 0.001). The most frequent alteration associated with malnutrition was loss of appetite (odds ratio [OR]: 8.8, confidence interval [CI] 95% 2.9-26.9, p<0.001), followed by fear of feeding (OR: 3.14, CI 95% 1.24-7.9, p=0.015), and the organic causes showed the highest risk for malnutrition (OR: 3.1, CI 95% 0.98-9.7, p=0.054).

Conclusions: Over 90% of the studied population demonstrated at least one eating disorder or feeding difficulty. The principal effect is inadequate nutritional intake due to limited appetite and fear of feeding, which can result in undernutrition. For this reason, the identification of alterations in nutrition processes should be part of the comprehensive assessment of cancer patients.
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http://dx.doi.org/10.24875/BMHIM.19000072DOI Listing
February 2020

Expression of YY1 in Wilms tumors with favorable histology is a risk factor for adverse outcomes.

Future Oncol 2019 Apr 27;15(11):1231-1241. Epub 2019 Feb 27.

Unidad de Investigación en Enfermedades Oncológicas, Hospital Infantil de México, Federico Gómez, Mexico City, Mexico.

Aim: To investigate the role of the transcription factor YY1 in Wilms tumor (WT).

Patients & Methods: We measured YY1 expression using tissue microarray from patients with pediatric renal tumors, mainly WT and evaluated correlations with the predicted clinical evolution. YY1 expression was measured using immunohistochemical and protein expression was determined by digital pathology.

Results & Conclusion: YY1 significantly increased in WT patients. In addition, an increase in YY1 expression had a greater risk of adverse outcomes in WT patients with favorable histology. YY1 expression was higher in the blastemal component of tumors, and high nuclear expression positively correlated with metastasis. YY1 may be considered as a metastasis risk factor in WT.
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http://dx.doi.org/10.2217/fon-2018-0764DOI Listing
April 2019

Validation of an instrument to measure the quality of life in children with oropharyngeal mucositis undergoing cancer treatment.

Bol Med Hosp Infant Mex 2019 ;76(1):35-43

Departamento de Oncología Médica, Instituto Nacional de Pediatría, Secretaría de Salud, Cuidad de México. México.

Background: Oropharyngeal mucositis (OM) is one of the primary complications arising during oncological treatment, which significantly reduces the patient's quality of life (QoL). The aim of this study was to translate, culturally adapt, and validate the use of a new Spanish version of the Oropharyngeal Mucositis-Specific Quality-of-Life instrument (OMQoL) for pediatric patients.

Methods: A multicentric, cross-sectional validation study was conducted to translate and adapt OMQoL from English to Spanish for its use by children with OM aged 8-16 years. Reliability was measured using Cronbach's alpha; content and construct validity, in conjunction with exploratory factor analysis. The convergent validity, with the correlations of the scales for OM defined by the WHO, OMAS (Oropharingeal Mucositis Assessment Scale) and the PedsQL-3 cancer module in Spanish.

Results: One hundred and ninety-three children with mean age of 10.91 ± 2.38 years participated in the study, out of which 101 (52.3%) were females. In this sample, 80 children (41.5%) suffered from acute lymphoblastic leukemia and 111 (57.5%) had grade 2 and 3 OM. The factorial analysis resulted in four dimensions with loads >0.40. Among the 31 items of the OMQoL, six were eliminated. Cronbach alpha of OMQoL-Spanish was 0.954. Spearman´s correlations (r) with the OMS and OMAS scales were significant (with r = -0.720 and r = -0.689; p < 0.01, respectively). Moderate correlation was observed with the PedsQL-3 cancer module (r = 0.426; p < 0.01).

Conclusions: OMQoL-Spanish demonstrated adequate psychometric properties, resulting in a reliable and valid instrument for measuring QoL in children with MO.
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http://dx.doi.org/10.24875/BMHIM.18000146DOI Listing
January 2020

Centromere-associated protein E expresses a novel mRNA isoform in acute lymphoblastic leukemia.

Int J Mol Epidemiol Genet 2018 20;9(5):43-54. Epub 2018 Oct 20.

Experimental Oncology Laboratory, Research Department, National Institute of Pediatrics Mexico City, Mexico.

The alternative splicing plays an important role to generate protein diversity. Recent studies have shown alterations in alternative splicing, resulting in loss, gain or changes of functions in the resulting protein. Specific products of alternative splicing are known to contribute in cancer-related mechanisms, such as angiogenesis, migration, adhesion and cell proliferation, among others. We using high-density microarrays reported a CENP-E as a one of significant transcript expressed and potentially is alternatively spliced in cancer. We focus in validate alternative splicing of CENP-E transcript using RT-PCR and sequencing in different cancer cell lines. We performed RT-PCR using specific primers designed to delimit the non-reported alternative splicing in CENP-E transcript. Our results showed the co-expression of the variant one and two of CENP-E in all cell lines evaluated. We detected more expression of variant one than two. Moreover, we identify an alternative 5'splice site of CENP-E in the exon 38 and was observed in RoVa cell line. Additionally, we characterized alternative skipping from exon 20 (NAT-CENP-E), these alternative splicing was observed in all cell lines evaluated except RoVa. Finally, we corroborate alternative mRNA splicing in leukemia patients using quantitative RT-PCR, in 71.8% of the patients NAT-CENP-E is downregulated and 28.2% is overexpressed.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6261922PMC
October 2018

A strategy for the clinical remission of acute lymphoblastic leukemia elicited by treatment of β-thalassemia major: A case report.

Mol Clin Oncol 2018 Feb 8;8(2):375-377. Epub 2017 Dec 8.

Department of Hematology, Hospital Infantil de México Federico Gómez, Mexico City 06720, Mexico.

Acute lymphoblastic leukemia (ALL) has been suggested as a long-term complication in patients with β-thalassemia major (β-TM). A 12-months-old male patient was diagnosed with β-TM. The patient required a blood transfusion weekly for 2 years. At the age of 4 years, a splenectomy was performed due to massive splenomegaly and frequent transfusion requirements. The histopathological analysis of the spleen revealed extensive hemosiderosis. ALL-L1 with the T immunophenotype and without central nervous system (CNS) involvement was diagnosed when the patient was 5 years old, and treated with anti-leukemic combination chemotherapy and CNS radiotherapy. The patient completed 24 months of treatment and has been in complete remission for 7 years, without long-term adverse events.
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http://dx.doi.org/10.3892/mco.2017.1533DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5776416PMC
February 2018

Current outlook of childhood cancer epidemiology in a middle-income country under a public health insurance program.

Pediatr Hematol Oncol 2017 Feb 13;34(1):43-50. Epub 2017 Mar 13.

b Department of Pediatric Oncology , National Institute of Pediatrics (NIP) , Mexico City , Mexico.

In Mexico, childhood cancer (0-18 years) is treated in a multidisciplinary way while providing care for more than half of the affected children through a public medical insurance. This insurance is given to all children who do not have any health care coverage in Mexico. This program is offered to the poorest of all Mexicans. All the children with this disease are submitted to pathology diagnosis and treatment according to national treatment protocols from 57 accredited medical institutions. From 2007 to 2015, a total of 24,039 children with cancer have been registered; the male gender predominates by 55%. The highest incidence was in the group aged between 0 and 4 years. Every year, there has been an increment in registration. In 2015, there were 3,433 new patients with an incidence of 150.1/million. In the same year, the incidence for all types of leukemia increased to 89.5/million. But for acute lymphoblastic leukemia, the incidence was found to be 79.8/million, which is extremely high. The mortality rate for all these patients in 2015 was 5.3/100,000. However, with regard to children aged between 15 and 18 years, the mortality rate was 8.5/100,000. Abandonment rate was 10%, and there were nine state institutions that had a mortality rate between 25% and 50% among their patients. Coincidentally, as per the Human Development Index, the parameters for education, health, and income were low for those nine institutions. The purpose of this work is to show the epidemiology and the burden we are facing due to this disease.
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http://dx.doi.org/10.1080/08880018.2016.1276236DOI Listing
February 2017

Development of the SIOPE DIPG network, registry and imaging repository: a collaborative effort to optimize research into a rare and lethal disease.

J Neurooncol 2017 04 21;132(2):255-266. Epub 2017 Jan 21.

Department of Paediatrics, Division of Oncology/Haematology, VU University Medical Center, Amsterdam, The Netherlands.

Diffuse intrinsic pontine glioma (DIPG) is a rare and deadly childhood malignancy. After 40 years of mostly single-center, often non-randomized trials with variable patient inclusions, there has been no improvement in survival. It is therefore time for international collaboration in DIPG research, to provide new hope for children, parents and medical professionals fighting DIPG. In a first step towards collaboration, in 2011, a network of biologists and clinicians working in the field of DIPG was established within the European Society for Paediatric Oncology (SIOPE) Brain Tumour Group: the SIOPE DIPG Network. By bringing together biomedical professionals and parents as patient representatives, several collaborative DIPG-related projects have been realized. With help from experts in the fields of information technology, and legal advisors, an international, web-based comprehensive database was developed, The SIOPE DIPG Registry and Imaging Repository, to centrally collect data of DIPG patients. As for April 2016, clinical data as well as MR-scans of 694 patients have been entered into the SIOPE DIPG Registry/Imaging Repository. The median progression free survival is 6.0 months (95% Confidence Interval (CI) 5.6-6.4 months) and the median overall survival is 11.0 months (95% CI 10.5-11.5 months). At two and five years post-diagnosis, 10 and 2% of patients are alive, respectively. The establishment of the SIOPE DIPG Network and SIOPE DIPG Registry means a paradigm shift towards collaborative research into DIPG. This is seen as an essential first step towards understanding the disease, improving care and (ultimately) cure for children with DIPG.
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http://dx.doi.org/10.1007/s11060-016-2363-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5378734PMC
April 2017

The burden of childhood cancer in Mexico: Implications for low- and middle-income countries.

Pediatr Blood Cancer 2017 06 1;64(6). Epub 2016 Dec 1.

Department of Pediatric Oncology, National Institute of Pediatrics (NIP), Mexico City, Mexico.

In Mexico, childhood cancer incidence and mortality have increased in the last decade. Through government actions since 2005, the Popular Medical Insurance (PMI) program for childhood cancer was created. The objective of PMI was to offer early cancer diagnosis, standardized treatment regimens, and numerous pediatric oncology residency programs. It has also accredited 55 national hospitals for the care of these children. Current problems still present under the PMI include shortage of pediatric oncologists and nurses and high rate of abandonment of treatment. Our aim is to describe the current scenario of childhood cancer care in Mexico, especially from the perspective of the PMI and how it has impacted human resources, infrastructure, and medical education.
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http://dx.doi.org/10.1002/pbc.26366DOI Listing
June 2017

Instruments to measure the quality of life in patients with oral mucositis undergoing oncological treatment: a systematic review of the literature.

Bol Med Hosp Infant Mex 2016 Nov - Dec;73(6):457-466. Epub 2016 Dec 1.

Departamento de Oncología Médica, Instituto Nacional de Pediatría, Mexico City, Mexico. Electronic address:

Background: Oral mucositis (OM) is an inflammatory reaction of the oropharyngeal mucosa to cumulative chemotherapy (CT) and radiation therapy (RT), affecting one or more parts of the digestive tract along with the quality of life (QoL) of the patient. The goal of this study was to identify valid and reliable tools to evaluate QoL related to OM.

Methods: A systematic review of the literature was conducted up to May 2016. Articles were selected by peers using the PubMed database through a search following the inclusion and exclusion criteria and STAndards for the Reporting of Diagnostic accuracy studies (STARD) checklist with a cut-off point ≥ 70%.

Results: We identified four relevant articles that described instruments to assess the QoL related to OM in patients undergoing cancer treatment.

Conclusions: The evaluation of the QoL in patients with OM is a difficult scenario because of its multiple variables. The knowledge of this relationship is limited because general instruments of oral health or cancer therapy are commonly used for evaluation. However, valid instruments are already available for estimating the impact of OM on the QoL from the patient's perspective.
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http://dx.doi.org/10.1016/j.bmhimx.2016.10.007DOI Listing
December 2016

Descriptive Epidemiology in Mexican children with cancer under an open national public health insurance program.

BMC Cancer 2014 Oct 29;14:790. Epub 2014 Oct 29.

Head of the Division of Pediatric Hem/Oncology, National Institute of Pediatrics (NIP), Coordinator for the Technical Committee of the National Council for the Prevention and Treatment of Childhood Cancer, Mexico City, Mexico.

Background: All the children registered at the National Council for the Prevention and Treatment of Childhood Cancer were analyzed. The rationale for this Federal Government Council is to financially support the treatment of all children registered into this system. All patients are within a network of 55 public certified hospitals nationwide.

Methods: In the current study, data from 2007 to 2012 are presented for all patients (0-18 years) with a pathological diagnosis of leukemia, lymphoma and solid tumors. The parameters analyzed were prevalence, incidence, mortality, and abandonment rate.

Results: A diagnosis of cancer was documented in 14,178 children. The incidence was of 156.9/million/year (2012). The median age was 4.9. The most common childhood cancer is leukemia, which occurs in 49.8% of patients (2007-2012); and has an incidence rate of 78.1/million/year (2012). The national mortality rate was 5.3/100,000 in 2012, however in the group between 15 to 18 years it reaches a level of 8.6.

Conclusions: The study demonstrates that there is a high incidence of childhood cancer in Mexico. In particular, the results reveal an elevated incidence and prevalence of leukemia especially from 0 to 4 years. Only 4.7% of these patients abandoned treatment. The clinical outcome for all of the children studied improved since the establishment of this national program.
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http://dx.doi.org/10.1186/1471-2407-14-790DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4228174PMC
October 2014

[Malignant neoplasms in the neonate].

Bol Med Hosp Infant Mex 2014 Sep - Oct;71(5):261-270. Epub 2015 May 19.

Enseñanza, Instituto Nacional de Pediatría, México D.F., México.

Cancer in children has characteristics that differentiate it from other types reported in later ages. Overall survival at 3 years is up to 70% depending on the tumor studied. Major organs and systems affected are the hematopoietic system, central nervous system and sympathetic and mesenchymal tissues. The increased incidence of neonatal tumors observed in this and other studies is based on the increasing number of solid tumors (teratomas and neuroblastomas) because cases of central nervous system tumors and leukemias have remained constant. Ultrasonography is the first line of approach and can detect up to 70% of fetal anomalies. The physiology of the newborn causes the necessary multidisciplinary treatment in neoplastic disease to be modified substantially in this age group to avoid toxicity and sequelae. The most common treatment is surgery. Achieving timely diagnostic treatment options are effective in improving the survival of these patients.
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http://dx.doi.org/10.1016/j.bmhimx.2014.05.004DOI Listing
May 2015

Interleukin-1 receptor antagonist gene polymorphism increases susceptibility to septic shock in children with acute lymphoblastic leukemia.

Pediatr Infect Dis J 2013 Feb;32(2):136-9

Division of Pediatric Oncology, Hospital Infantil de Mexico Federico Gomez, Mexico City, Mexico.

Background: Interleukin-1 receptor antagonist polymorphism (ILRN) 2 (ILRN*2) has been associated with a poor outcome in septic patients because of an elevated production of anti-inflammatory cytokines. In >70% of patients, morbidity and mortality in childhood acute lymphoblastic leukemia is caused by infections. The aim of this study was to determine the association between this polymorphism and the frequency of septic shock from the time of diagnosis until completion of treatment.

Methods: This cohort study was conducted in 57 consecutive children with acute lymphoblastic leukemia. At the end of follow-up, children were stratified according to their IL1RN polymorphism (ILRN*1/ILRN*2), evaluating the impact of genotype on the severity of febrile neutropenic events during their treatment.

Results: Overall survival was 80% at 55 months after treatment. The average number of febrile neutropenic events in this cohort was 2.82 per patient. Genotype distribution was 50.9% for homozygote IL-1RN*1, 38.6% for heterozygote ILRN*1/ILRN*2 and 10.5% for homozygote IL-1RN*2. The risk of presenting septic shock for homozygote IL1RN*2/IL1RN*2 and heterozygote ILRN*1/ILRN*2 patients was significantly greater (odds ratio, 45; P = 0.001) adjusted for age, gender, risk of leukemia and presence of pathogenic bacteria. Genotype IL-1RN*2 is associated with the risk of development of septic shock in children with acute lymphoblastic leukemia. Further research in larger population-based studies is needed to replicate these findings.

Conclusions: This information would allow us to identify more predictive factors in this group of acute lymphoblastic leukemia patients in whom this information is lacking to establish an earlier and more aggressive approach.
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http://dx.doi.org/10.1097/INF.0b013e31827566ddDOI Listing
February 2013

Scaling up cancer care for children without medical insurance in developing countries: The case of Mexico.

Pediatr Blood Cancer 2013 Feb 8;60(2):196-203. Epub 2012 Aug 8.

Division of Social Protection and Health, Inter American Development Bank, Mexico City, Mexico.

Background: In 2006, the Mexican government launched the Fund for Protection Against Catastrophic Expenditures (FPGC) to support financially healthcare of high cost illnesses. This study aimed at answering the question whether FPGC improved coverage for cancer care and to measure survival of FPGC affiliated children with cancer.

Procedure: A retrospective cohort study (2006-2009) was conducted in 47 public hospitals. Information of children and adolescents with cancer was analyzed. The coverage was estimated in accordance with expected number of incident cases and those registered at FPGC. The survival was analyzed by using Kaplan-Meier survival curves and Cox proportional hazards regression modeling.

Results: The study included 3,821 patients. From 2006 to 2009, coverage of new cancer cases increased from 3.3% to 55.3%. Principal diagnoses were acute lymphoblastic leukemia (ALL, 46.4%), central nervous system (CNS) tumors (8.2%), and acute myeloid leukemia (AML, 7.4%). The survival rates at 36 months were ALL (50%), AML (30.5%), Hodgkin lymphoma (74.5%), Non-Hodgkin lymphoma (40.1%), CNS tumors (32.8%), renal tumors (58.4%), bone tumors (33.4%), retinoblastoma (59.2%), and other solid tumors (52.6%). The 3-year overall survival rates varied among the regions; children between the east and south-southeast had the higher risks (hazard ratio 3.0; 95% CI: 2.3-3.9) and 2.4; 95% CI: 2.0-2.8) of death from disease when compared with those from the central region.

Conclusion: FPGC has increased coverage of cancer cases. Survival rates were different throughout the country. It is necessary to evaluate the effectiveness of this policy to increase access and identify opportunities to reduce the differences in survival.
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http://dx.doi.org/10.1002/pbc.24265DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3561702PMC
February 2013

Long-term survival in children under 3 years of age with low-grade astrocytoma.

Childs Nerv Syst 2007 May 17;23(5):543-7. Epub 2007 Jan 17.

Division of Hem/Oncology and Radiotherapy, National Institute of Pediatrics [Instituto Nacional de Pediatría], Insurgentes Sur no. 3700-C, Mexico City, D F, 04530, México.

Objective: The purpose of this study is to analyze clinical aspects and disease-free survival (DFS) in children less than 3 years of age diagnosed with low-grade astrocytoma.

Methods: In a period of 24 years (1980-2004), a total of 43 (5.4%) children were registered with these characteristics. Twenty-three patients had pilocytic astrocytoma, 18 diffused, and 2 mixed. Thirty-one (72.1%) children had incomplete surgical tumor resection and 12 (27.9%) had a complete tumor resection. Twelve (27.9%) patients had cranial radiotherapy and 17 (39.5%) received chemotherapy. Overall survival was recorded in 23 (53%). DFS was 50% at 250 months of follow-up for the whole group. DFS for the supratentorial group was 60% at 250 months, whereas, for the infratentorial, it was 22% at 120 months (p = 0.008).

Conclusion: The only favorable prognostic pattern was the supratentorial presentation. Radiotherapy and chemotherapy did not alter the outcome.
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http://dx.doi.org/10.1007/s00381-006-0287-0DOI Listing
May 2007

Brain tumors in children under 1 year of age: emphasis on the relationship of prognostic factors.

Childs Nerv Syst 2003 Jun 6;19(5-6):311-4. Epub 2003 May 6.

Department of Oncology, Instituto Nacional de Pediatría, Insurgentes Sur 3700-C, 04530, Mexico City, Mexico.

Objects: Primary brain tumors in infants under 12 months of age have a different prognosis from older children.

Material: A retrospective analysis was done in all patients less than 12 months old with primary brain tumors.

Results: Out of 1682 children with primary brain tumors, 61 (3.6%) were infants under 12 months old. The mean age at diagnosis was 181.6 days (SD 128) with a range of 1 to 364 days. There were 37 males (60.6%). The most common tumor was astrocytoma ( n=22) (36%). Supratentorial tumors were present in 63.9% but this was not related to survival ( p=0.1095). Complete surgical resection ( n=14) was favorable for survival ( p=0.039). Intracranial hypertension at diagnosis did not influence survival ( p=0.89). The overall survival rate was 32%, mean 42.08 (SD 7.38). A total of 24 patients are alive and without evidence of disease.

Conclusion: Complete surgical resection was necessary for a favorable prognosis, and the long-term effects are a valid problem.
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http://dx.doi.org/10.1007/s00381-003-0738-9DOI Listing
June 2003