加沙地带儿科急性淋巴细胞白血病治疗的护理障碍和结果。

Barriers to Care and Outcomes of Pediatric Acute Lymphoblastic Leukemia Treatment in the Gaza Strip.

机构信息

Boston Children's Hospital.

Harvard Medical School, Boston, MA.

出版信息

J Pediatr Hematol Oncol. 2022 Jan 1;44(1):e123-e126. doi: 10.1097/MPH.0000000000002338.

DOI:10.1097/MPH.0000000000002338

PMID:34705357

Abstract

BACKGROUND

Childhood acute lymphoblastic leukemia (ALL) is the most common pediatric cancer worldwide. Although children in high-income countries enjoy survival rates of ~90%, children in countries with limited resources suffer from survival rates of <35%. No published data on pediatric cancer incidence, management, or outcomes in the Gaza Strip are available.

METHODS

A retrospective cohort study was undertaken for pediatric (below 12 y of age) ALL diagnoses admitted to the only pediatric cancer ward in the Gaza Strip between 2010 and 2015. Outcomes included event-free survival (EFS) and overall survival (OS) calculated by Kaplan-Meier estimates. Events were defined as induction failure, relapse, and death.

RESULTS

The 3-year EFS estimate was 80% (95% confidence interval [CI], 66%-89%). The EFS at 1 and 3 years for high-risk ALL was 55% (95% CI, 27%-76%) and 23% (95% CI, 4%-51%), respectively. The 3-year OS was 93% (95% CI, 82%-97%). The 3-year OS for high-risk ALL was 69% (95% CI, 30%-90%). All 84 (100%) patients required referral to an outside hospital for definitive ALL diagnoses and induction therapy. Forty-four (52%) patients required at least one additional referral.

CONCLUSIONS

The overall outcomes demonstrated relatively high survival rates at 3 years which may be artificially elevated due to exclusion of adolescents, limited follow up, and deceased patient charts unavailable. Structural determinants of health in Gaza lead to limited diagnostic and treatment capabilities, limited access to advanced medical training, and reliance on out-of-territory transfers for care. These barriers impact the access to comprehensive pediatric care within the Gaza Strip.

摘要

背景

儿童急性淋巴细胞白血病（ALL）是全世界最常见的儿科癌症。尽管高收入国家的儿童存活率约为 90%，但资源有限国家的儿童的存活率却低于 35%。目前尚无加沙地带儿科癌症发病率、管理和结局的相关数据。

方法

对 2010 年至 2015 年间加沙地带唯一一家儿科癌症病房收治的所有 12 岁以下儿童 ALL 患者进行了回顾性队列研究。结局包括无事件生存（EFS）和总生存（OS），采用 Kaplan-Meier 估计法计算。事件定义为诱导失败、复发和死亡。

结果

3 年 EFS 估计值为 80%（95%置信区间[CI]：66%-89%）。高危 ALL 的 1 年和 3 年 EFS 分别为 55%（95%CI：27%-76%）和 23%（95%CI：4%-51%）。3 年 OS 为 93%（95%CI：82%-97%）。高危 ALL 的 3 年 OS 为 69%（95%CI：30%-90%）。84 例（100%）患者均需转诊至外部医院以明确 ALL 诊断和诱导治疗。44 例（52%）患者至少需要转诊一次。