Show simple item record

dc.contributor.advisorOchoa Vera, Miguel Enrique
dc.contributor.advisorSossa Melo, Claudia Lucía
dc.contributor.authorRíos Quintero, Sandra Vanessa
dc.coverage.spatialBucaramanga (Santander, Colombia)spa
dc.coverage.temporal2013-2020spa
dc.date.accessioned2021-08-19T22:32:30Z
dc.date.available2021-08-19T22:32:30Z
dc.date.issued2021
dc.identifier.urihttp://hdl.handle.net/20.500.12749/13929
dc.description.abstractIntroducción: la leucemia linfoblástica aguda (LLA) se asocia con pobre sobrevida a largo plazo. Dos estrategias que han impactado mortalidad, medición de enfermedad mínima residual (EMR) y blinatumumab, están disponibles desde 2016 en la FOSCAL (segundo cuatrienio), pero su impacto sobre los resultados clínicos en la población local no se conoce. Objetivo: comparar las tasas de mortalidad y sobrevida libre de enfermedad a 12 meses entre los periodos 2013-2016 y 2017-2020 en esta población. Materiales y métodos: se registró retrospectivamente información sociodemográfica y de evolución clínica de los pacientes con LLA atendidos en la FOSCAL. Se describen las características de los pacientes al diagnóstico y se compararon los desenlaces entre los dos periodos de interés, expresados como tasas (mortalidad y sobrevida libre de enfermedad), calculando riesgos relativos e intervalos de confianza del 95% crudos y ajustados por covariables. Resultados: se incluyeron 128 pacientes en el estudio. La edad media al diagnóstico fue 34,6 años (DS: 18,3), predominó ligeramente el sexo masculino (53,91%). Del total de pacientes, 68 y 60 fueron atendidos en el primer y segundo cuatrienio respectivamente. La proporción de sobrevida libre de enfermedad fue del 91,07% y la mortalidad del 34,38%. Al comparar estos dos desenlaces por cuatrienios, no se encontraron diferencias estadísticamente significativas (p=0,196). El uso de blinatumumab y alcanzar respuesta completa con EMR negativa fueron factores protectores para mortalidad, pero no fueron estadísticamente significativos. Ser llevado a trasplante de progenitores hematopoyéticos mostró una disminución de riesgo para mortalidad (HR 0,12; IC 0,37-0,39, p= <0,01). Conclusiones: aunque se observó una ligera disminución de mortalidad y mejoría en sobrevida libre de enfermedad en el segundo cuatrienio en comparación con el primero, estas diferencias no fueron estadísticamente significativas. Es necesario continuar con el seguimiento a largo plazo de estos pacientes, ya que las tasas de mortalidad aumentan con el tiempo.spa
dc.description.tableofcontents1. Planteamiento y justificación del problema ................................................ 6 2. Marco teórico ................................................................................................... 7 2.1 Leucemia Linfoblástica aguda .................................................................................. 7 2.2 Tratamiento .............................................................................................................. 9 2.3 Enfermedad mínima residual ................................................................................. 10 2.4 Recaída de la enfermedad ...................................................................................... 11 3. Estado del arte ............................................................................................. 12 4. Objetivos ...................................................................................................... 14 3.1 Objetivo general..................................................................................................... 14 3.2 Objetivos específicos ............................................................................................. 14 5. Metodología ................................................................................................. 15 5.1 Tipo de estudio ....................................................................................................... 15 5.2 Población................................................................................................................ 15 5.3 Criterios de inclusión y exclusión .......................................................................... 15 5.4 Muestra .................................................................................................................. 16 5.5 Recolección de información .................................................................................. 16 6. Hipótesis .................................................................................................................... 16 7. Variables ................................................................................................................... 17 8. Plan de análisis de datos .......................................................................................... 25 8.1 Análisis estadístico univariado ................................................................................ 25 9. Consideraciones éticas ............................................................................................. 26 10. Resultados ...................................................................................................... 28 11. Discusión........................................................................................................ 46 12. Fortalezas y debilidades .................................................................................. 50 13. Conclusiones .................................................................................................. 51 ANEXOS .............................................................................................................. 53 Referencias bibliográficas ..................................................................................... 56spa
dc.format.mimetypeapplication/pdfspa
dc.language.isospaspa
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/2.5/co/*
dc.titleCaracterización epidemiológica de leucemia linfoide aguda con base en la población atendida en la FOSCAL, 2013 – 2020 y su comparación por cuatrieniosspa
dc.title.translatedPopulation-based epidemiological characterization of acute lymphoid leukemia attended at FOSCAL, 2013-2020 and its comparison by four-year periodspa
dc.degree.nameEspecialista en Medicina Internaspa
dc.publisher.grantorUniversidad Autónoma de Bucaramanga UNABspa
dc.rights.localAbierto (Texto Completo)spa
dc.publisher.facultyFacultad Ciencias de la Saludspa
dc.publisher.programEspecialización en Medicina Internaspa
dc.description.degreelevelEspecializaciónspa
dc.type.driverinfo:eu-repo/semantics/masterThesis
dc.type.localTesisspa
dc.type.coarhttp://purl.org/coar/resource_type/c_bdcc
dc.subject.keywordsInternal medicinespa
dc.subject.keywordsMedicinespa
dc.subject.keywordsMedical sciencesspa
dc.subject.keywordsHealth sciencesspa
dc.subject.keywordsAcute lymphoblastic leukemiaspa
dc.subject.keywordsMortalityspa
dc.subject.keywordsLeukemiaspa
dc.subject.keywordsNeoplasmsspa
dc.subject.keywordsPathogenesisspa
dc.identifier.instnameinstname:Universidad Autónoma de Bucaramanga - UNABspa
dc.identifier.reponamereponame:Repositorio Institucional UNABspa
dc.type.hasversioninfo:eu-repo/semantics/acceptedVersion
dc.rights.accessrightsinfo:eu-repo/semantics/openAccessspa
dc.rights.accessrightshttp://purl.org/coar/access_right/c_abf2spa
dc.relation.references1. Kaushansky K, Lichtman M.A, Prchal J.F et al. Williams Hematology. 2016. 1505– 21 p.spa
dc.relation.references2. Pui CH, Relling MV DJ. Acute Lymphoblastic Leukemia. N Engl J Med. 2004;350(15):1535–48spa
dc.relation.references3. Rambaldi A, Thomas X, Horst H, Brüggemann M. Blinatumomab versus Chemotherapy for Advanced Acute Lymphoblastic Leukemia. N Engl J Med. 2017;376(9):836–47.spa
dc.relation.references4. Bain BJ. Acute Lymphoblastic Leukaemia and Acute Leukaemia of Ambiguous Lineage. In: Leukaemia Diagnosis. 2017. p. 249–78.spa
dc.relation.references5. NCCN Evidence Blocks. Acute Lymphoblastic Leukemia. Natl Compr Cancer Netw. 2020;spa
dc.relation.references6. Sociedad Argentina de Hematología. Leucemias Agudas. Guías diaGnóstico y Trat. 2017;spa
dc.relation.references7. Combariza JF, Casas CP, Rodríguez M, Al. E. Supervivencia en adultos con leucemia linfoide aguda de novo tratados con el esquema HyperCVAD en el Instituto Nacional de Cancerología (Colombia), entre enero de 2001 y junio de 2002. Rev Colomb CanCeRol. 2007;11(2):92–100spa
dc.relation.references8. Ching-Hon Pui WEE. Treatment of Acute Lymphoblastic Leukemia. N Engl J Med. 2006;354(2):166–78.spa
dc.relation.references9. Instituto Nacional de Cancerología. Guía de práctica clínica para la detección, tratamiento y seguimiento de leucemias linfoblástica y mieloide en población mayor a 18 años. Guia No 34. 2017spa
dc.relation.references10. Jennifer L. McNeer AB. Acute lymphoblastic leukemia and lymphoblastic lymphoma in adolescents and young adults. PediatrBloodCancer. 2018;e26989.spa
dc.relation.references11. McNeer J, Bleyer A. Burden of hospitalization in relapsed acute lymphoblastic leukemia. Curr Med Res Opin. 2016;32(7):1209–12spa
dc.relation.references12. Eapen M. Best Practice & Research Clinical Haematology. Best Pract Res Clin Haematol. 2017;30:317–9.spa
dc.relation.references13. Canet E, Zafrani L, Lambert J, Al. E. Acute Kidney Injury in Patients with Newly Diagnosed High-Grade Hematological Malignancies: Impact on Remission and Survival. PLoS One. 2013;8(2):E55870.spa
dc.relation.references14. Thomas X, Thiebaut A, Olteanau N, Et. al. Philadelphia chromosome positive adult acute lymphoblastic leukemia: characteristics, prognostic factors and treatment outcome. Hematol Cell Ther. 1998;40(3):119–28spa
dc.relation.references15. Fielding A, Rowe J, Richards S, et al. Prospective outcome data on 267 unselected adult patients with Philadelphia chromosome- positive acute lymphoblastic leukemia confirms superiority of allogeneic transplantation over chemotherapy in the pre- imatinib era: results from the International ALL . Blood. 2009;113(19):4489–96spa
dc.relation.references16. Oriol A, Vives S, Hernandez-Rivas J, Al E. Outcome after relapse of acute lymphoblastic leukemia (ALL) in adult patients included in four consecutive risk- adapted trials from the PETHEMA Study Group. Haematologica. 2010;95:589–96spa
dc.relation.references17. Bassan R, Spinelli O, Oldani E. Improved risk classification for for risk-specific therapy based on the molecular study of MRD in adult ALL. Blood. 2009;113:4153– 62.spa
dc.relation.references18. Ribera J. Quimioterapia e imatinib, seguido de trasplante de progenitores hematopoyéticos en adultos jóvenes (edad inferior a 55 años) con leucemia aguda linfoblástica ph (bcr-abl) positiva. 2013spa
dc.relation.references19. Bruggemann M, Raff M, Flohr T. Clinical significance of minimal residual disease quantification in adult patients with standard risk acute lymphoblastic leukemia. Blood. 2006;107:116–1123.spa
dc.relation.references20. Gökbuget N, Stanze D, Beck J, Diedrich H. Freund M, Hoelzer D; German Multicenter Study Group for Adult Acute Lymphoblastic Leukemia. Outcome of relapsed adult lymphoblastic leukemia depends on response to salvage chemotherapy, prognostic factors, and performance of stem cell transplantation. Blood. 2012;120(10):2032–41spa
dc.relation.references21. Cuenta de alto costo. Situación de cáncer en la población adulta atendida en el SGSSS de Colombia 2018. Bogotá D.C; 2018spa
dc.relation.references22. Sossa C, Peña A, Muentes Z, Arenas M, Serrano S. Survival of Acute Lymphoblastic Leukemia: Experience of a Single Center in Colombia. Clinical Lymphoma, Myeloma & Leukemia. 2018.spa
dc.relation.references23. Gökbuget N, Dombret H, Giebel S, Bruggemann M. Minimal residual disease level predicts outcome in adults with Ph-negative B-precursor acute lymphoblastic leukemia. Hematology. 2019;24(1):337–48.spa
dc.relation.references24. Gupta R, Othman T, Uche A, et. al. Characteristics and Trends of Adult Acute Lymphoblastic Leukemia in a Large, Public Safety-Net Hospital. Clin Lymphoma. 2020;20(6):e320–7.spa
dc.relation.references25. Instituto nacional de salud. Encuesta nacional de salud [Internet]. 2015. Available from: https://www.icbf.gov.co/bienestar/nutricion/encuesta-nacional-situacion- nutricionalspa
dc.relation.references26. Radaelli A, Stephens J, Laskin B, Pashos C. The burden and outcomes associated with four leukemias: AML, ALL, CLL and CML. Expert Rev Anticancer Ther. 2003;3(3):311–29spa
dc.relation.references27. Pulte D, Jansen L, Brenner H. Changes in long term survival after diagnosis with common hematologic malignancies in the early 21st century. Blood Cancer J. 2020;10(5):56.spa
dc.relation.references28. Ribera J, Ribera M, Montesinos P, Tormo M. PETHEMA Group, Spanish Society of Hematology. A pediatric regimen for adolescents and young adults with Philadelphia chromosome-negative acute lymphoblastic leukemia: Results of the ALLRE08 PETHEMA trial. Cancer Med. 2020;9(7):2317–29spa
dc.relation.references29. Stock W, et al. A pediatric regimen for older adolescents and young adults with acute lymphoblastic leukemia: results of CALGB 10403. Blood. 2019;133(14):1548–59spa
dc.relation.references30. Liu Q, Major B, Le-Rademacher J, Al-Kali A. he Impact of Obesity on the Outcomes of Adult Patients with Acute Lymphoblastic Leukemia - A Single Center Retrospective Study. Blood Lymphat Cancer. 2021;11:1–9spa
dc.relation.references31. Ravandi F, Jorgensen J, O´Brien S, et al. Minimal residual disease assessed by multi- parameter flow cytometry is highly prognostic in adult patients with acute lymphoblastic leukaemia. Br J Haematol. 2016;172(3):392–400spa
dc.relation.references32. Goldstone A, Wiernik P, Foroni L, Paietta E. In adults with standard-risk acute lymphoblastic leukemia, the greatest benefit is achieved from a matched sibling allogeneic transplantation in first complete remission, and an autologous transplantation is less effective than conventional consolidation/. Blood. 2008;111:111:1827–1833.spa
dc.relation.references33. Geibel S, Boumendill A, Labopin M, Seesaghur A. Trends in the use of hematopoietic stem cell transplantation for adults with acute lymphoblastic leukemia in Europe: a report from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT). Ann Hematol. 2019;98:2389–98spa
dc.relation.references34. Shem-Tov N, Peczynski C, Labopin M, Itälä-Remes M. Haploidentical vs. unrelated allogeneic stem cell transplantation for acute lymphoblastic leukemia in first complete remission: on behalf of the ALWP of the EBMT. Leukemia. 2020;34(1):283–92.spa
dc.relation.references35. Muffly L, Li Q, Alvarez E, Kahn J. Hematopoietic Cell Transplantation in Young Adult Acute Lymphoblastic Leukemia: A United States Population-Level Analysis. J Adolesc Young Adult Oncol. 2019;8(3):254–61spa
dc.relation.references36. Centre for international blood and marrow transplant research. The US Summary Slides - HCT Trends and Survival Data [Internet]. 2020. Available from: https://www.cibmtr.org/ReferenceCenter/SlidesReports/SummarySlides/pages/inde aspx qspa
dc.relation.references37. Jabbour E, O´Brien S, Konopleva M, Kantarjian H. New insights into the pathophysiology and therapy of adult acute lymphoblastic leukemia. Cancer. 2015;121:2517–28.spa
dc.relation.references38. Bassan R, Hoelzer D. Modern therapy of acute lymphoblastic leukemia. Clin Oncol. 2011;20:532–43spa
dc.relation.references39. Herrera-Garza J, Gutiérrez-Aguirre H, Marfil-Rivera L, Gómez-Almaguer D. Survival Rates of Adults With Acute Lymphoblastic Leukemia in a Low-Income Population: A Decade of Experience at a Single Institution in Mexico. Myeloma Leuk. 2017;17(1):60–8.spa
dc.relation.references40. Stock W, et al. A pediatric regimen for older adolescents and young adults with acute lymphoblastic leukemia: results of CALGB. Blood. 2019;133(14):1548–59.spa
dc.relation.references41. Siegel S, Stock W, Johnson R. Pediatric-inspired treatment regimens for adolescents and young adults with Philadelphia chromosomeenegative acute lymphoblastic leukemia: a review. JAMA Oncol. 2018;4:725–34.spa
dc.relation.references42. Jastaniah W. Improving survival outcomes of childhood acute lymphoblastic leukemia: A 25-year experience from a single center in Saudi Arabia. Pediatr Blood Cancer. 2019;66(11):e27782spa
dc.relation.references43. Bailey C, Richardson L, Allemani C, Bonaventure A. Adult leukemia survival trends in the United States by subtype: A population-based registry study of 370,994 patients diagnosed during 1995-2009. Cancer. 2018;124(19):3856–67spa
dc.contributor.cvlacSossa Melo, Claudia Lucía [0001425704]spa
dc.contributor.cvlacOchoa Vera, Miguel Enrique [0000898465]spa
dc.contributor.googlescholarSossa Melo, Claudia Lucía [n1PL8iUAAAAJ&hl=es&oi=ao]spa
dc.contributor.orcidOchoa Vera, Miguel Enrique [0000-0002-4552-3388]spa
dc.contributor.researchgateSossa Melo, Claudia Lucía [Claudia-Sossa]spa
dc.contributor.researchgateOchoa Vera, Miguel Enrique [Miguel-Enrique-Ochoa-2186675588]spa
dc.subject.lembMedicina internaspa
dc.subject.lembMedicinaspa
dc.subject.lembCiencias médicasspa
dc.subject.lembLeucemiaspa
dc.subject.lembNeoplasmasspa
dc.subject.lembPatogénesisspa
dc.identifier.repourlrepourl:https://repository.unab.edu.cospa
dc.description.abstractenglishIntroduction: acute lymphoblastic leukemia (ALL) is associated with poor long-term survival. Two strategies that have impacted mortality, minimal residual disease measurement (MRD) and blinatumumab, have been available since 2016 in FOSCAL (second four-year period), but their impact on clinical outcomes in the local population is not known. Objective: to compare the 12-month disease-free survival and mortality rates between the periods 2013-2016 and 2017-2020 in this population. Materials and methods: sociodemographic information and clinical evolution of patients with ALL treated at FOSCAL were retrospectively recorded. The characteristics of the patients at diagnosis are described and the outcomes between the two periods of interest were compared, expressed as rates (mortality and disease-free survival). calculating crude relative risks and 95% confidence intervals adjusted for covariates. Results: 128 patients were included in the study. The mean age at diagnosis was 34.6 years (SD: 18.3), with a slight predominance of males (53.91%). Of the total number of patients, 68 and 60 were seen in the first and second four years respectively. The disease-free survival rate was 91.07% and mortality was 34.38%. To the comparing these two outcomes by four-year period, no statistically significant differences were found (p = 0.196). The use of blinatumumab and achieving a complete response with negative EMR were protective factors for mortality, but were not statistically significant. Being taken to hematopoietic stem cell transplantation showed a decreased risk for mortality (HR 0.12; CI 0.37-0.39, p = <0.01). Conclusions: although there was a slight decrease in mortality and improvement in disease-free survival in the second four-year period compared to the first, these differences were not statistically significant. Long-term follow-up of these patients is necessary, since mortality rates increase with time.spa
dc.subject.proposalCiencias de la saludspa
dc.subject.proposalLeucemia linfoblástica agudaspa
dc.subject.proposalMortalidadspa
dc.type.redcolhttp://purl.org/redcol/resource_type/TM
dc.rights.creativecommonsAtribución-NoComercial-SinDerivadas 2.5 Colombia*


Files in this item

Thumbnail
Thumbnail
Thumbnail

This item appears in the following Collection(s)

Show simple item record

Atribución-NoComercial-SinDerivadas 2.5 Colombia
Except where otherwise noted, this item's license is described as Atribución-NoComercial-SinDerivadas 2.5 Colombia