The Acute Lymphoblastic Leukemia (ALL) is the most common cancer in the childhood, but
the disease’s kind of evolution and the quality of the assistance which the pediatric patients
receive are unknown in a lot of regions in the world – among them, the Amazon region, in
Brazil. OBJECTIVE: To identify a local profile of pediatric patients diagnosed with ALL and
assisted in a reference health service in the Amazon region; to describe the ALL in its clinical
and laboratorial presentation and to analyze some clinical-epidemiological factors influences
in three of the possible endings in this population: complete clinical remission, relapse and
death. METHODS: Clinical-epidemiological study (observational, individual and analytic),
with a retrospective design in series of cases, from 2003 to 2011. Patients with ALL were
included according the following characteristics: to be from zero to twelve years old; and to
be admitted from January/2003 to January/2008, in the Pediatric Sector of the Ofir Loyola
Hospital (OLH). RESULTS: There were 152 patients in the study: 62.5% were boys and
37.5% girls. The age’s peak of incidence was with three years old and the average, 5.1 years
old. Browns, Whites, Blacks, Indians and Yellows races/colors were found in this population:
71.1%, 11.2%, 3.9%, 0.7%, 0.7% and 12.5%, respectively. The origin was distributed among:
Belem metropolitan region (27.6%), other towns in Para State (55.3%) and cities in other
Brazilian States (16.4%). The spent time between the symptoms beginning and the admission
at the OLH was 65.8 days (average). In the admission, 8.5% had central nervous system
infiltration and 1% of the boys had testicle infiltration. Pancytopenia was the most found
laboratorial standard, just as the blasts cells count over 85% in myelogram. There was more
ALL cells B occurrence (36.2%) than other kinds, just as the subtype B common (30.2%).
98% of the treatments used chemotherapy protocols; only 0.7% of the patients was submitted
to the bone marrow transplantation. The found endings were: death during the treatment
(52%); complete clinical remission/cure (30.2%); treatment continuous to the first clinical
remission (5.3%); treatment of relapse after the first finished treatment (4.6%); treatment of
relapse without finishing the first treatment (3.9%); abandonment (3.3%); transference
(0.7%). There was significant statistical association between: death and age, brown color, lack
of pain in limbs in the admission, presentation of mucositis as co-morbidity on the diagnosis,
no change of chemotherapy protocol during the treatment, no realization of intrathecal
therapy, sepsis during the treatment, just as relapse and a long time of treatment; between
relapse, male sex and late change of protocol; between cure and age, pale skin on the
diagnosis and pain in limbs in the admission, realization of intrathecal therapy, no change of
protocol, lack of relapse and having a treatment with a longer time. CONCLUSION: With
significant statistical association mainly linked to the clinical presentation on the diagnosis
and admission and to the conducts and complications during the treatment, it is responsibility
of the health service reanalyze proposals of improvements to the assistance with the main
objective of obtaining best results in the childhood cancer care in this Brazilian region.
|
