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Alessandra Sala

Publications and source records attributed to Alessandra Sala.

13 recordsLinked to original sources
PubMed2007

Improving outcomes for children with cancer in low-income countries in Latin America: a report on the recent meetings of the Monza International School of Pediatric Hematology/Oncology (MISPHO)-Part I.

The difference in survival for children diagnosed with cancer between high- and low-income countries (LIC) continues to widen as curative therapies are developed in the former but not implemented in the latter. In 1996, the Monza International School of Pediatric Hematology/Oncology (MISPHO) was founded in an attempt to narrow this survival gap. During its sixth and seventh meetings, members recognized the problem of lack of affordability of essential drugs to treat childhood cancer in many LIC, and initiated an advocacy program. In 1998, MISPHO spawned a collaboration of Central American pediatric oncology centers: the Asociación de Hemato-Oncología Pediátrica Centroamericana (AHOPCA). AHOPCA members reported preliminary findings from several of the 10 cooperative protocols that are currently in progress. In 2003, a second regional collaborative group was formed that includes seven centers in South America. Twinning programs between MISPHO centers and centers in high-income countries (HIC) have proven invaluable to harness the resources of these centers to improve pediatric oncology care in LIC. MISPHO educational efforts include oncology nursing, supportive care, cancer-specific updates, epidemiology, and clinical research methods. Educational efforts are facilitated by educational content and online conferencing via www.cure4kids.org. Identifying preventable causes of abandonment of therapy and documenting the nutritional status of patients treated at MISPHO centers are areas of active research.

Adolescent↗
PubMed2006

Osteonecrosis in children and adolescents with cancer - an adverse effect of systemic therapy.

Osteonecrosis (ON) is recognised increasingly as a complication of the treatment of cancer in children and adolescents. It is especially prevalent among survivors of acute lymphoblastic leukaemia and non-Hodgkin lymphoma, in whom as many as 1/3 may be affected, likely reflecting the cumulative exposure to glucocorticosteroid therapy. The pathogenesis is complex and includes suppression of bone formation, expansion of the intra-medullary lipocyte compartment and a direct effect on nutrient arteries. Children > or =10 years of age are at particular risk and the disorder is substantially more common in Whites than in Blacks. Genetic predispositions have been identified. ON is often multi-articular and bilateral, affecting weight-bearing joints predominantly. Surgical management options are of concern in young growing subjects, although injection of autologous marrow into affected sites offers promising results. Other novel approaches include the use of anti-resorptive drugs and strategies for prevention, such as with lipid-lowering agents, are being explored.

Adolescent↗
PubMed2006

Effect of diagnostic radioisotopes and radiographic contrast media on measurements of lumbar spine bone mineral density and body composition by dual-energy x-ray absorptiometry.

Since there is almost no information on whether the concomitant use of diagnostic radioisotopes and radiographic contrast media interferes with dual-energy X-ray absorptiometry (DXA), we investigated these potentially confounding effects. At routine scheduled radiographic follow-up, 40 patients previously treated for malignant lymphomas or solid tumors in Hamilton and Ottawa, Canada were evaluated, 10 in each of the following 4 categories of diagnostic procedure: (1) computed tomography (CT) with intravenous, iodine-based contrast (+/-oral contrast), (2) magnetic resonance imaging (MRI) with gadolinium-based contrast, (3) gallium scan (GS), and (4) technetium bone scan (TBS). Whole body bone mineral content (WB-BMC) and lumbar spine bone mineral density (LS-BMD), total fat mass (TFM), and lean body mass (LBM) were measured by DXA immediately before and after the other radiological studies (on the same day) and then 7 days later. No statistically significant differences were found among WB-BMC, LS-BMD, TFM, and LBM Z-scores immediately before and after MRI, GS, TBS, and 7 days later. The DXA measurements performed immediately before and after CT showed statistically significant differences in WB-BMC (100% vs 124.5%, p<0.001), TFM (100% vs 75.4%, p<0.001), and LBM (100% vs 110%, p<0.001), resulting from the CT contrast agents compromising the precision of the DXA. The DXA results after 7 days were not statistically different from those at baseline. Dual-energy X-ray absorptiometry can be performed in association with other radiological techniques, with the exception of CT conducted with contrast within 1 week. This study provides information that applies not only to patients with cancer but to the general population undergoing diagnostic procedures.

Absorptiometry, Photon↗
PubMed2005

Quality-adjusted survival: a rigorous assessment of cure after cancer during childhood and adolescence.

Survivors of cancer in childhood and adolescence, while increasing gratifyingly in number with ever more effective therapy, have a life expectancy that is compromised all-too-often in both duration and value as a result of adverse treatment-related sequelae. Accounting for this burden of morbidity and mortality is essential for a proper appreciation of cure. Adjusting estimates of survival by measures of its quality affords a means of accomodating this requirement. It can be accomplished by "weighting" the length of survival according to preference-based assessments of health-related quality of life (HRQL), which allow the calculation of quality-adjusted life years. Inclusion of measures of HRQL in clinical trials is imperative as we reach to the ultimate objective; the truly cured child restored to normal health.

Adolescent↗
PubMed2005

Serum creatinine: a surrogate measurement of lean body mass in children with acute lymphoblastic leukemia.

BACKGROUND: Since creatinine is formed almost exclusively in skeletal muscle, the hypothesis of a relationship between serum creatinine (SC) and lean body mass (LBM), determined by dual-energy X-ray absorptiometry (DXA), was tested. METHODS: Two cohorts of patients were analyzed: 37 children with acute lymphoblastic leukemia (ALL) and 20 children with primary muscular disorders (PMD). The latter cohort was used as a comparative group. Statistical analyses were performed using linear regressions. RESULTS: A strong correlation was demonstrated between SC and LBM in the patients with PMD (r = 0.77) and in patients with ALL (r = 0.83 at diagnosis; r = 0.77 on therapy; and r = 0.56 off therapy). The correlation between SC and body size (body mass index) was much weaker (r = 0.38; r = -0.09; r = 0.29 at the successive observations in the ALL cohort and r = 0.05 in the PMD cohort). These data provide support for the initial hypothesis. CONCLUSIONS: Further investigations with a wider variety of diseases are needed for this will allow the consideration of SC as a general surrogate measure of LBM and consequently of nutritional status.

Biomarkers↗
PubMed2004

Children, cancer, and nutrition--A dynamic triangle in review.

The overall cure rate for cancer in childhood now exceeds 70% and is projected to reach 85% by the year 2010 in industrialized countries. Therefore, major attention is being placed on reducing the side effects of therapy. However, 85% of the world's children live in developing countries, where access to adequate care often is limited and health status frequently is influenced adversely by prevalent infectious diseases and malnutrition. Despite several confounding factors (different definitions of nutritional status, the wide variety of measures used for its assessment, the selection biases by disease and stage, treatment protocols of variable dose intensity and efficacy, small sample sizes of the studies conducted in the last 20 years), it is accepted that the prevalence of malnutrition at diagnosis averages 50% in children with cancer in developing countries; whereas, in industrialized countries, it is related to the type of tumor and the extent of the disease, ranging from < 10% in patients with standard-risk acute lymphoblastic leukemia to 50% in patients with advanced neuroblastoma. The importance of nutritional status in children with cancer is related to its possible influence on the course of the disease and survival. Some authors have described decreased tolerance of chemotherapy associated with altered metabolism of antineoplastic drugs, increased infection rates, and poor clinical outcome in malnourished children. In this article, the authors review methods of nutritional assessment and the pathogenesis of nutritional morbidity in children with cancer as well as correlations of nutritional status with diagnosis, treatment, and outcome.

Child↗
PubMed2004

A survey of resources and activities in the MISPHO family of institutions in Latin America: a comparison of two eras.

BACKGROUND: In developing countries, implementation of effective pediatric cancer programs can reduce the overall rate of childhood mortality. To promote this objective, Monzas International School of Pediatric Hematology-Oncology (MISPHO)--for 14 countries with limited resources in Latin America--was launched in 1996. METHODS: A survey was conducted to evaluate the possible impact of MISPHO on the following areas: research, educational, and clinical activities, diagnostic services, transfusion medicine, supportive care, ancillary staffing complement, and parents' associations--before and after 1996. RESULTS: No institution lost resources or activities after 1996 and there were overall gains, in particular in educational activities, diagnostic capabilities, creation of single and multiple institutional treatment protocols. CONCLUSIONS: Although notable improvements have occurred, there are still important needs that have to be satisfied.

Child↗
PubMed2003

Nutritional support for children with cancer.

Children with cancer are at risk of suffering from under nutrition, which can affect tolerance of therapy and may influence their overall survival. The goals of nutritional support in the cancer patient are to achieve and maintain desirable weight and to prevent or correct nutritional deficiencies. So early identification of patients at high risk for malnutrition is essential. There are different options for nutritional support. Oral feeding, when possible, is the first line. Enteral nutrition should be considered for those patients who cannot consume adequate macronutrients by mouth. Options are nasogastric tube or gastrostomy tube feeding. The advantages of enteral nutrition, when compared with parenteral nutrition, include better maintenance of the structural and functional integrity of the gastrointestinal tract, a decreased risk of bacterial translocation, greater ease and safety of administration, more physiologic and efficient use of nutrient substrates, decreased hepato-biliary complications, improved outcome and cost-effectiveness. Thus, parenteral nutrition should be considered if the gut is not functioning adequately to allow the normal absorption and digestion of nutrients or if enteral nutritional support is not sufficient to meet nutritional needs. Nutritional assessment and support should be integrated into treatment protocols for all children with neoplastic diseases.

Child↗