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Friedrich P, Mercado N, Echeandia-Abud N, Guerrero-Gomez K, González-Zamorano M, López-Ruíz MI, Portillo-Zavala CS, García-Segura LD, Reynoso-Gutiérrez M, López-Facundo NA, Cárdenas-Pedraza D, Valois-Escamilla MG, Mera-González AB, Covarrubias-Zapata D, Vollbrechtshausen-Castelán LA, Loeza-Oliva JDJ, Garay-Sánchez SA, Moreno-Serrano J, Mendoza-Sánchez P, Casillas-Toral P, Sandoval-Cabrera A, Gutiérrez-Martínez I, Jiménez-Osorio MI, Arce-Cabrera D, Aguilar-Escobar DV, González-Montalvo PM, Romo-Rubio HA. Securing access to a comprehensive diagnostic panel for children with suspected acute lymphoblastic leukemia: Results from the Mexico in Alliance with St. Jude "Bridge Project". Front Oncol 2024; 13:1286278. [PMID: 38288107 PMCID: PMC10824571 DOI: 10.3389/fonc.2023.1286278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/07/2023] [Indexed: 01/31/2024] Open
Abstract
Background The "Bridge Project" is a Mexico in Alliance with St. Jude (MAS) initiative developed in 2019 to improve access, accuracy, and timeliness of specialized diagnostic studies for patients with suspected acute lymphoblastic leukemia (ALL). The project strategy relies on service centralization to improve service delivery, biological characterization, risk-group classification, and support proper treatment allocation. Methods This is an ongoing prospective multisite intersectoral quality improvement (QI) project available to all patients 0-18 years of age presenting with suspected ALL to the 14 actively participating institutions in 12 Mexican states. Institutions send specimens to one centralized laboratory. From a clinical standpoint, the project secures access to a consensus-derived comprehensive diagnostic panel. From a service delivery standpoint, we assess equity, timeliness, effectiveness, and patient-centeredness. From an implementation science standpoint, we document feasibility, utility, and appropriateness of the diagnostic panel and centralized approach. This analysis spans from July 2019 to June 2023. Results 612 patients have accessed the project. The median age was 6 years (IQR 3-11), and 53% were males. 94% of the specimens arrived within 48 hours, which documents the feasibility of the centralized model, and 100% of the patients received precise and timely diagnostic results, which documents the effectiveness of the approach. Of 505 (82.5%) patients with confirmed ALL, 463/505 (91.6%) had B-cell ALL, and 42/505 (8.3%) had T-cell ALL. High-hyperdiploidy was detected by DNA index in 36.6% and hypodiploidy in 1.6%. 76.6% of the patients had conclusive karyotype results. FISH studies showed t(12;21) in 15%, iAMP21 in 8.5%, t(1;19) in 7.5%, t(4;11) in 4.2%, t(9;22) in 3.2%, del(9)(p21) in 1.8%, and TRA/D (14)(q11.2) rearrangement in 2.4%. Among B-cell ALL patients, 344/403 (85.1%) had Day 15 MRD<1% and 261/305 (85.6%) Day 84 MRD<0.01. For T-cell ALL patients 20/28 (71.4%) had Day 29 MRD<0.01% and 19/22 (86.4%) Day 84 MRD<0.01%. Conclusions By securing access to a standardized consensus-derived diagnostic panel, the Bridge Project has allowed better characterization of childhood ALL in Mexico while producing unprecedented service improvements and documenting key implementation outcomes. We are using these results to inform iterative changes to the diagnostic panel and an associated treatment guideline (MAS-ALL18).
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Affiliation(s)
- Paola Friedrich
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Nataly Mercado
- Casa de la Amistad para Niños con Cáncer, Institución de Asistencia Privada, I.A.P., Ciudad de México, Mexico
| | - Naomi Echeandia-Abud
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Karla Guerrero-Gomez
- Casa de la Amistad para Niños con Cáncer, Institución de Asistencia Privada, I.A.P., Ciudad de México, Mexico
| | - Margarita González-Zamorano
- Pediatric Oncology and Hematology Department, Hospital General con Especialidades “Juan María de Salvatierra”, La Paz, Mexico
| | - Mayra Ivette López-Ruíz
- Pediatric Oncology Department, Hospital de Especialidades Pediátricas, Tuxtla Gutiérrez, Mexico
| | | | | | | | - Norma Araceli López-Facundo
- Pediatric Oncology Department, Hospital Materno Infantil del Instituto de Seguridad Social del Estado de México y Municipios, Toluca, Mexico
| | - Daniela Cárdenas-Pedraza
- Pediatric Oncology and Hematology Department, Hospital para el Niño del Instituto Materno Infantil del Estado de México, Toluca de Lerdo, Mexico
| | | | - Alma Beatriz Mera-González
- Hematology Department, Hospital del Niño Desarrollo Integral de la Familia (DIF) Hidalgo, Pachuca de Soto, Mexico
| | - Daniela Covarrubias-Zapata
- Pediatric Oncology Department, Centro Estatal de Oncología “Dr. Luis González Francis”, Campeche, Mexico
| | | | - José de Jesús Loeza-Oliva
- Pediatric Oncology Department, Centro Estatal de Cancerología “Dr. Miguel Dorantes Mesa”, Xalapa, Mexico
| | | | - Julio Moreno-Serrano
- Diagnostic and Bood Bank Department, Hospital Infantil Teletón de Oncología, Querétaro, Mexico
| | | | - Paola Casillas-Toral
- Pediatric Oncology and Hematology Department, Hospital Civil de Guadalajara “Dr. Juan I. Menchaca”, Guadalajara, Mexico
| | - Antonio Sandoval-Cabrera
- Pediatric Oncology and Hematology Department, Hospital para el Niño del Instituto Materno Infantil del Estado de México, Toluca de Lerdo, Mexico
| | - Itzel Gutiérrez-Martínez
- Pediatric Oncology Department, Hospital Infantil de Morelia "Eva Sámano de López Mateos", Morelia, Mexico
| | | | - Daniela Arce-Cabrera
- Pediatric Oncology and Hematology Department, Hospital Pediátrico de Sinaloa, Culiacán, Mexico
| | | | | | - Hugo Antonio Romo-Rubio
- Pediatric Oncology and Hematology Department, Hospital Civil de Guadalajara “Dr. Juan I. Menchaca”, Guadalajara, Mexico
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Mahajan A, Arora RS, Sahi PK, Gomber S, Radhakrishnan N, Bagchi B, Jain P, Kumar A, Singh A, Gupta H, Sharma S, Ahamad N, Bagai P, Kumar A. Shared care for children with cancer in India through social and healthcare partnerships during the COVID-19 pandemic. Cancer Rep (Hoboken) 2021; 5:e1486. [PMID: 34180154 PMCID: PMC8420228 DOI: 10.1002/cnr2.1486] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 05/31/2021] [Accepted: 06/14/2021] [Indexed: 11/20/2022] Open
Abstract
Background The COVID pandemic posed a challenge for the tertiary centers to continue treatment. Some tertiary centers were designated as COVID‐only hospitals, making it difficult for existing childhood cancer patients to continue their treatment at those centres. The need for shared care in childhood cancer was perceived by Cankids and its partnering childhood cancer‐treating centers in North and East India. Aim We aim to show how Cankids upscaled its shared care model to ensure that COVID designated hospitals connected with other hospitals who have to continue to provide care to childhood cancer patients in the pandemic and thus ensured the continuation of treatment for these patients. Methods and result The need assessment of the beneficiaries was done in discussion with the hospital of origin and destination hospital. The need for shared care was also discussed with the families and consent was taken before shifting their children. Cankids with the help of advisors identified cases of high risk that need immediate attention, proactive regular monitoring, and help in care planning with the perspective and recommendation of the multiple providers. The shared care unit came forward with reasonable and discounted packages for treatment. There was a total of five hospitals requiring shared care, and 55 children were supported from April to November 2020. The median age was 8 years and their hospital of origin are in Bihar, Uttar Pradesh, West Bengal, and Delhi. The expenditure on the treatment of the 55 patients was INR 61 61 636 ($ 84 843), with a median of INR 41765 (IQR 19491–174 129) on each patient. Total 291 trips for the transport were arranged and all the patients combined stayed 174 days at Cankids accommodation facility. Conclusion The shared care helped the patients access standard treatment and reduce the financial burden.
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Affiliation(s)
- Amita Mahajan
- Department of Pediatrics Oncology and Hematology, Indraprastha Apollo Hospital, Delhi, India
| | | | - Puneet Kaur Sahi
- Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, Delhi, India
| | - Sunil Gomber
- Department of Pediatric, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Nita Radhakrishnan
- Department of Paediatric Hemato-Oncology, Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida, Uttar Pradesh, India
| | - Basab Bagchi
- Department of Medical Oncology & Haematology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Prachi Jain
- Department of Pediatric Oncology, Max Super Specialty Hospital, Vaishali, Delhi, India
| | - Arvind Kumar
- Department of Hemato-Oncologist, Buddha Cancer Centre, Patna, Bihar, India
| | - Avinash Singh
- Department of Hemato-Oncology, Paras HMRI Hospital, Patna, Bihar, India
| | - Haresh Gupta
- Department of Medical Projects and Social Support Program, Cankids Kidscan, Delhi, India
| | - Sonal Sharma
- Department of Medical Projects and Social Support Program, Cankids Kidscan, Delhi, India
| | - Nasim Ahamad
- Department of Medical Projects and Social Support Program, Cankids Kidscan, Delhi, India
| | - Poonam Bagai
- Department of Medical Projects and Social Support Program, Cankids Kidscan, Delhi, India
| | - Arvind Kumar
- Department of Medical Projects and Social Support Program, Cankids Kidscan, Delhi, India
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