Browsing by Autor "Jose Macias Abasto"

Now showing 1 - 2 of 2

Acute Myeloid Leukemia: Diagnosis and treatment at a tertiary center in cochabamba - Bolivia.
(Elsevier BV, 2025) Veronica Saavedra; Cristian Rodrigo Lazo; Yolanda Muñoz; Martin Carroll; Carlos Telleria; Carlos Aguilar-Franco; Jose Macias Abasto; Ximena Jordan Bruno
Abstract Background Acute myeloid leukemia (AML) is a clinically and biologically complex disease. During the last decade, classification, prognostic scores and treatment have been reviewed. AML with PML::RARA fusion (acute promyelocytic leukemia, APL) has a better prognosis when treatment, based on trans retinoic acid (ATRA), plus arsenic trioxide (ATO) or chemotherapy is not delayed. In Bolivia there is a scarce availability of drugs for the treatment of AML. Very few are commercially available but only daunorubicin, doxorubicin and cytarabine are provided by the public health insurance called, Seguro universal de Salud (SUS). ATRA isn't even imported to the country and most of the support treatments aren't available either. Cochabamba is the third biggest city of the country, with 2.005.373 inhabitants. Hospital Viedma, is the only tertiary public hospital of the city that manages oncologic patients from SUS. It still carries paper-based charts and most of the data from patients who die or loose follow up are destroyed or stored and unavailable for review. Aims. To describe the characteristics of the AML population in our scenery and to know if the basic standards for diagnosis and treatment are met. Methods. We created a record coming from the hospital statistics department and our own bone marrow aspirate (BMA) registry from January 2019 to December 2024 (58 patients). We managed to review, 36 medical records of adult AML patients with a minimal time from diagnosis to analysis of four months. Demographics, baseline disease characteristics, treatment and response were collected. Results. Twenty (55.6%) were from the capital. Five (14%) had APL, all of them diagnosed in 2024. APL patients: Four (80%) were male between ages 19 and 41 years. All of them had hypofibrinogenemia and thrombocytopenia; Four (80%) had bleeding complications; 3 of them, CNS hemorrhages, (2 died, unable to get ATRA). Three (60%) were treated with ATRA (but delayed) with an anthracycline, and achieved complete responses after induction, 2, didn't continue to consolidation, but are alive 11 and 5 months after induction treatment. None of the patients were admitted to the intensive care unit, or received fibrinogen concentrates. The remaining 31 (86%) AML patients had a median of age at diagnosis of 35 years (R 15-79), 13 (42%) were male and 18 (58%) female. None of the patients in our hospital had baseline cytogenetic tests, and four (15%) had a molecular biology test via PCR (PML; RARA, FLT3, NPM1, CEBPA, or BCR/ABL). Four patients were not assessed due to previous diagnosis or treatment in other hospitals. Of 27 newly diagnosed AML patients (non APL), 3 (11%) are alive, and the remaining had abandoned treatment (7, 27%), or died (17, 62%). The main cause of death registered were infections (7, 41%) and relapse/progressive disease (5, 29.4%). Seven (26%) had hyperleukocytosis at diagnosis. Twenty-three (85%) received intensive treatment with 7 plus 3. Sixteen (70%) received daunorubicin and 7 (30%) doxorubicin at 30 mg/m2. Mean time from diagnosis to treatment was 12 days, and median time of hospital stay was 18 days. None of the patients received anti-fungal prophylaxis. Seven (26%) treated patients died within 30 days, 2 of them the first week since diagnosis, and 3 (11%) abandoned follow up after discharge. Out of the 14 (52%) first-month survivors, 8 (57%) achieved morphological complete response (CR) with MRD negative disease by flow cytometry analysis. Four (28.5 %) did not achieve a CR and 2 (14.2%) failed to do the reevaluation. Three (75%) of the patients that didn't attain CR, received the same first line treatment again and none of them survived. Conclusions. This report shows real-word evidence on management of AML in Bolivia. Relevant information was missed due to deficient medical record management. We couldn't classify or stratify risk according to international guidelines due to missing basic diagnostic tests. There is a high rate of treatment abandonment in our population, probably due to socio-economic factors. We have a younger population of AML patients compared to most epidemiological evidence, with a high mortality rate and virtually no access to targeted or second-line treatments. Shortness of ATRA availability is especially challenging. We need extensive report on cases from other hospitals throughout the country to better understand AML in Bolivia in order to improve patient care and insurance coverage in our country.
Real-world outcomes of primary gastric diffuse large B cell lymphoma in Latin America: A multicenter cohort from the grupo de estudio latinoamericano de linfoproliferativos (GELL)
(Elsevier BV, 2025) Rafael Pichardo-Rodríguez; Brady Beltrán; Luis Mario Villela Martínez; Carolina Oliver; Marialejandra Torres Viera; Luis Felipe Rubalcava; Arianna Robles Rodriguez; Rosio Baena; Jose Macias Abasto; Melanie Castro-Mollo
Abstract INTRODUCTION: Primary gastric diffuse large B-cell lymphoma (PG-DLBCL) is a rare and heterogeneous entity within extranodal non-Hodgkin lymphomas. Due to its low prevalence, data on clinical characteristics, treatment patterns, and survival outcomes in real-world settings, particularly in Latin America, remain limited. This study aimed to describe the clinical features and treatment outcomes of patients with PG-DLBCL and to evaluate prognostic factors associated with overall survival (OS). METHODS: We conducted a multicenter, retrospective cohort study using data from the GELL registry (2015–2024), which includes adult patients diagnosed with primary gastric diffuse large B-cell lymphoma (PG-DLBCL) and treated at academic hematology centers across Latin America. Consecutive patients who received first-line immunochemotherapy with R-CHOP, R-miniCHOP, or similar rituximab-based anthracycline regimens were included. Patients lost to follow-up were excluded. Baseline clinical and laboratory variables were collected at diagnosis. The primary endpoint was overall survival (OS), defined as the time from diagnosis to death from any cause or last known follow-up. The secondary endpoint was event-free survival (EFS), defined as the time from diagnosis to progression, relapse, unplanned treatment change, or death. The median follow-up time was estimated using the reverse Kaplan–Meier method. Missing data (&lt;10%) were addressed via multiple imputation using Random Forest algorithms (mice R package). OS and EFS were estimated using the Kaplan–Meier method, and compared using the log-rank test. Multivariable Cox proportional hazards models were used to identify independent prognostic factors for OS and EFS. Predefined subgroup analyses were performed according to Helicobacter pylori (HP) status. RESULTS: A total of 157 patients were included. The median follow-up time was 35.5 months (Interquartile Range: 13.1–68.6) and 50 (32%) died during follow-up. The median age of 64 years and a slight male predominance (53%). Most patients had ECOG ≤1 (92%), no B symptoms (52%), and localized disease (55%). R-CHOP was the most common first-line regimen (80%), with ≥6 cycles completed in 61% of cases. Based on NCCN-IPI, 46% had high-intermediate or high-risk scores (≥3). Relapse occurred in 12%, and overall mortality was 32%, mainly due to disease progression and sepsis. Most patients received R-CHOP or equivalent first-line therapy. Radiotherapy was used in 9.5% of deceased and 12.0% of surviving patients. OS at 36 months was 70% (95% CI: 62–78. EFS at 36 months was 80% (95% CI: 73–88. In multivariable analysis, age (HR: 1.05 per year; 95% CI: 1.02–1.07; p &lt; 0.001), ECOG ≥2 (HR: 7.32; 95% CI: 3.09–17.3; p &lt; 0.001), and advanced stage (HR: 2.57; 95% CI: 1.27–5.17; p = 0.008) were independently associated with increased mortality. For EFS, older age (HR = 1.03; 95% CI: 1.00–1.06; p = 0.033), ECOG ≥2 (HR = 12.3; 95% CI: 4.23–35.9; p &lt; 0.001), and advanced stage (HR = 4.95; 95% CI: 1.62–15.2; p = 0.005) were independently associated with worse outcomes. In a subanalysis of 60 patients with known Helicobacter pylori status, HP-positive patients had significantly higher overall survival at 12 and 24 months (91.7% at both timepoints) compared to HP-negative patients (60.7% at 12 months and 56.7% at 36 months) and higher complete response rates (61% vs. 33%). Complete response was more common in HP-positive patients (46% vs. 26%). Disease progression (22% vs. 8%), relapse (2% vs. 0%), and treatment-related mortality (9% vs. 0%) were more frequent among HP-negative patients compared to those who were HP-positive. Conclusions In this Latin American cohort, PG-DLBCL patients showed favorable survival outcomes with standard immunochemotherapy. Advanced age, poor performance status, and advanced stage were independently associated with worse OS and EFS. Helicobacter pylori positivity was linked to better survival, higher complete response rates, and fewer adverse outcomes, suggesting its potential role as a favorable prognostic factor in PG-DLBCL.