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Acute lymphoblastic leukaemia represents 80% of all the cases of infantile leukaemias and it is one of the first malignant disease in those that therapeutic clinical studies have been made to great scale. With the improvement of the therapeutic outlines the prognosis of the children with acute lymphoblastic leukaemia has improved considerably in the last four decades, with rates of survival to the five years higher than 80%. The achievements in the “José Luis Miranda” Pediatric Hospital in Villa Clara is located at the level of national and internationally informed, with 84% of survival at five years and 16.5% of relapses; they are also informed late adverse effects.

Introduction: advances in the treatment of childhood acute lymphoblastic leukemia give a greater life expectancy for these patients. As the number of survivors increase, more long-term adverse effects are detected. Among the most frequent adverse effects stands late anthracycline cardiotoxicity (doxorubicin and daunorubicin), drugs widely used in almost all chemotherapy regimens, but which are related to cardiovascular damage. Objective: To describe the major late cardiovascular changes which are secondary to the use of chemotherapy for acute lymphoblastic leukemia diagnosed in childhood. Material and methods: A descriptive, longitudinal and retrospective study was conducted with 82 patients diagnosed with acute lymphoblastic leukemia, aged between zero and 15 years of age in the Oncohematology Department of the José Luis Miranda Pediatric University Hospital of Villa Clara from 1969 and 2009, who completed the planned treatment and were followed up in consultation from the moment of stopping treatment until May 2012. The patients who died before the study, those who received no treatment with anthracyclines and those who did not cooperate with the investigation were excluded. The cumulative dose of anthracyclines received and the time elapsed between the administration of the last dose and the beginning of the study was estimated in all patients. All patients were assessed by physical examination, electrocardiogram and echocardiogram. To assess systolic function, the left ventricular ejection fraction and the shortening fraction were measured; and for diastolic function, the E and A waves and the E/A relationship were measured. Results: Subclinical late cardiotoxicity predominated in patients treated with anthracyclines, which affected both sexes equally, with no significant differences concerning the age at diagnosis, or cumulative doses received. More cases affected appeared with increasing follow-up time.

Introducción: la leucemia mieloide aguda representa alrededor del 20 % de las leucemias agudas de la niñez con una respuesta al tratamiento y supervivencia menores que la leucemia linfoide aguda. Objetivo: describir los resultados obtenidos con el tratamiento de la leucemia mieloide aguda del niño en algunos centros de Cuba en el período 2000-2008. Métodos: se trataron 46 pacientes con leucemia mieloide aguda, se excluyeron los casos con leucemia promielocítica, diagnosticados a partir del año 2000 en las provincias occidentales, Sancti Spíritus y Villa Clara. Se aplicaron dos esquemas de tratamiento tipo BFM en dos períodos: en el primero (2000 -2003) se incluyeron 27 enfermos y en el segundo (2004-2008), 19. La diferencia fundamental entre los dos períodos consistió en la consolidación que en la segunda etapa fue de ciclos más intensos y cortos. Resultados: predominó el sexo masculino (n = 32) y la mediana de edad fue de 9 años. La remisión inicial fue del 71 % en la primera etapa y 89 % en la segunda. La supervivencia libre de eventos (SLE) en todos los pacientes fue del 40 % a los 5 años y la supervivencia global (SV) fue del 44 % en igual período. En la SLE en las dos etapas se encontraron diferencias significativas siendo mayor en la segunda. En los años comprendidos entre el 2000 y el 2003 la SV a los 5 años fue del 31 %, mientras que entre 2004 y 2008 fue del 63 %. No se empleó el trasplante de células progenitoras hematopoyéticas de forma sistemática. Conclusiones: estos resultados muestran un nivel comparable a los alcanzados a internacionalmente, lo que representa un importante logro del Sistema Nacional de Salud de Cuba.Introduction. acute myeloid leukemia represents about 20 % of all leukemias in childhood with results and survival smaller than in acute lymphoid leukemia. Objectives: to describe the results obtained with the treatment of acute myeloid leukemia in children in some Cuban centers in from 2000 to 2008. Methods: forty-six patients from Western provinces of Cuba including Sancti Spiritus and Villa Clara were treated. The majority of the patients were males. The median age was 9 years old. Two periods of treatment were applied, the first from 2000 to 2003 with 27 patients; and the second from 2004 to 2008 with 19 cases. The difference between the two periods was that in the second one the consolidation had short and intensive cycles. Results: the initial remission was 71 % in the first period and 89 % in the second. Free survival was 40 % in 5 years and the overall survival (OS) was 44 %, but in the first period the OS was 30,8 % and in the second it was 63,2 %. Immunophenotype and cytogenetic and molecular alterations were studied only in 10 children. Hematopoietic transplantation was not performed sytematically. Conclusions: these results show a level comparable to those achieved internationally, representing a major achievement of the Cuban National Health System.

The association of bone marrow aplasia and Turner syndrome is hardly mentioned in scientific literature. The case of a 12-year female patient that begins with fever and wet cough with yellowish expectoration and hemoptysis is reported. The patient showed a deterioration of the general condition and cutaneous-mucosal pallor. She underwent a chest radiograph that showed lesions of pneumonic aspect. Physical examination showed phenotypic abnormalities that are typical of Turner syndrome, which were confirmed by cytogenetic examination. In addition, hematological examination and bone marrow biopsy results were consistent with bone marrow aplasia. Based on the analysis of the clinical symptoms and other examinations conducted, it was concluded that the diagnosis of the patient's disease was bone marrow aplasia associated with Turner syndrome. This is the first report in Cuba of the association of these two illnesses.

Recombinant human erythropoietin is widely used in the treatment of anemia due to cancer. A retrospective, longitudinal and descriptive study was conducted at the Jose Luis Miranda Provincial Pediatric University Hospital in Santa Clara, Villa Clara, to evaluate the impact and effectiveness of the use of the Cuban product iorEPOCIM® in patients who suffer from anemia due to chemotherapy and / or radiotherapyin in the Hematology-Oncology service. An unintentional probabilistic sample was taken by criteria of 38 hospitalized patients who suffered from anemia, in the period from January 2005 to July 2006. The following variables were taken into account: age, sex, race, nutritional status, hemoglobin, transfusions before and after treatment and dose of erythropoietin. It was found that the drug significantly increased hemoglobin levels after four (55.3%, p=0.001) and eight (81.5%, p=0.035) weeks of treatment, with a significant decrease of transfusion requirements (p=0.027 and p=0.032) for both evaluations. The expected impact was not achieved but there was a therapeutic success, which helped to reduce the number of transfusions in patients. Therefore, the use of the medication for the treatment of anemia in these patients is a valuable alternative to improve their quality of life in general and reduces their risk of getting other conditions.

Introducción: la leucemia linfoide aguda (LLA) es la enfermedad maligna más frecuente en la infancia y la primera que se trató con un protocolo común en Cuba. Se han aplicado diferentes protocolos a lo largo del tiempo y actualmente existen en el país 10 centros que tratan niños con LLA. Objetivo: presentar los resultados alcanzados en el tratamiento de la LLA desde 2002 hasta 2008 con el protocolo del grupo ALLIC (Acute Lymphoblastic Leukemia Intercontinental). Métodos: se trataron 166 niños menores de 18 años al inicio de la enfermedad. Para conformar los grupos pronóstico se utilizaron diferentes criterios que incluyeron la edad y el número de leucocitos en el momento del diagnóstico, las alteraciones moleculares y la respuesta al tratamiento. Resultados: la supervivencia libre de eventos (SLE) a los 4 años fue del 69 % y la supervivencia global del 78 %. La SLE en los diferentes grupos pronósticos fue del 85 % para los pacientes de riesgo estándar, 77 % para los de riesgo intermedio y 59 % para los de riesgo alto. El porcentaje de remisión inicial fue inferior al obtenido por el grupo total. La mayoría de las muertes ocurrieron al inicio de la aplicación del protocolo. La recaída hematológica fue la causa más frecuente de terminación de la remisión completa. Las recaídas del sistema nervioso central, las testiculares y las combinadas fueron inferiores al 5 %. La presencia de reordenamientos genéticos del tipo bcr/abl o MLL/AF4 se confirmaron como elementos de muy mal pronóstico. Conclusiones: estos resultados, aunque son susceptibles de ser mejorados, muestran un nivel adecuado, sobre todo si se tiene en cuenta que se han logrado en un país en vías de desarrollo.