Childhood cancer and hematopoietic stem cell transplantation: a seven year experience at University Pediatric Hospital in Puerto Rico
Barrios, N.J.; Montalvo, F.; Colon, G.; Santiago Borrero, P.J.; Guerra, J.
Boletin de la Asociacion Medica de Puerto Rico 95(1): 21-25
2003
ISSN/ISBN: 0004-4849 PMID: 12898747 Document Number: 8463
The incidence rate of cancer in childhood in Puerto Rico (58 cases/per million persons/year) was estimated and limited on the basis of new cases admitted to the UPH and was similar to that of most industrialized countries. UPH is the only hospital treating childhood CNS tumors and our cases totally represent the incidence in Puerto Rico. The most common childhood cancer at the UPH was leukemia followed by CNS tumors, similar to that in North America, Western Europe and Latin America. For the malignant lymphomas, Hodgkin lymphoma is more common at UPH. In contrast the incidence rates for NHL, sarcomas, neuroblastoma, and Wilms tumor were similar. Rare tumors accounted for the remaining cases of cancer (11.6%). In our institution we used PBSC as the sole source for both autologous and allogeneic HSC transplantation after high-dose chemotherapy for malignant disease. The overall DFS for autologous (mean 3years) was 85%, and 50% for the allogeneic HSC transplantation (8 months). The mobilization and harvest procedures used at UPH proved to be safe and effective in both donor and the patients. PBSC as a source for HSC for both autologous and allogeneic transplantation offers the following advantage over bone marrow cell harvesting: ease of collection; faster kinetics of engrafment of hematopoietic lineages in comparison to bone marrow harvesting; short duration of antibiotic therapy and hospitalization. The information base was limited to our institution which carries certain limitations, however we can conclude the following. First, the general pattern of childhood cancer in Puerto Rico is similar to that of North America and Western Europe, except for Hodgkin lymphoma, which was more common at UPH. Second, the incidente of childhood CNS tumors in Puerto Rico is 12.2 cases/million persons/year. Third, autologous and allogeneic PBSC harvest and transplantation is feasible and easier for both the patient and the donor, and the results are very favorable when compared to experience of bone marrow transplant centers. It also reduced the cost-effective factors and added risk, such as anesthesia in our patient and donor population.
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