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Caracterización epidemiológica de leucemia linfoide aguda con base en la población atendida en la FOSCAL, 2013 – 2020 y su comparación por cuatrienios

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
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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*
dc.coverage.campusUNAB Campus Bucaramangaspa
dc.description.learningmodalityModalidad Presencialspa


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