title: Treatment of pediatric myelodysplastic syndromes and juvenile myelomonocytic leukemia: the Brazilian experience in the past decade.
abstract: BACKGROUND
  Therapy strategies for myelodysplastic syndromes (MDS) and juvenile myelomonocytic leukemia (JMML) vary considerably.
  
  
  OBJECTIVE
  To review the treatment of Brazilian children who were diagnosed with MDS or JMML in the past decade and reported to the Brazilian Cooperative Group on Pediatric Myelodysplastic Syndromes (BCG-MDS-PED).
  
  
  RESULTS
  Of 173 children reported to the BCG-MDS-PED from January 1997 to January 2003 with a suspected diagnosis of MDS or JMML, 91 had the diagnosis confirmed after central review of the bone marrow aspirate and biopsy. Information on previous treatments was available for 78 MDS/JMML patients. Treatment varied from different schedules of low-dose (14%) and standard-dose chemotherapy (50%), granulocyte-colony-stimulating factor (G-CSF 7%), interferon (5%), steroids (2%) and erythropoietin (2%) to allogeneic stem-cell transplantation (SCT) (14%). No survival advantage could be demonstrated based on Hasle's classification or based on treatment.
  
  
  CONCLUSIONS
  This report reflects the current practice in treating Brazilian children with MDS/JMML without specific Cooperative Group guidelines. Treatment modalities were very heterogeneous. The strategies for implementing a national protocol should consider international guidelines and focus on local experience and available resources.
authors.affiliation: Departamento de Puericultura e Pediatria, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Av. Bandeirantes, 3900 Monte Alegre, CEP 14049-900, Brazil. elvisvalera@hotmail.com
authors.forename: Elvis Terci
authors.initials: ET
authors.lastname: Valera
authors.forename: Maria do Rosário Dias
authors.initials: Mdo R
authors.lastname: Latorre
authors.forename: Wellington Luiz
authors.initials: WL
authors.lastname: Mendes
authors.forename: Adriana
authors.initials: A
authors.lastname: Seber
authors.forename: Maria Lucia Martino
authors.initials: ML
authors.lastname: Lee
authors.forename: Mario José Aguiar
authors.initials: MJ
authors.lastname: de Paula
authors.forename: Sandra Regina
authors.initials: SR
authors.lastname: Loggetto
authors.forename: Elvira
authors.initials: E
authors.lastname: Velloso
authors.forename: Ligia
authors.initials: L
authors.lastname: Niero-Melo
authors.forename: Luiz Fernando
authors.initials: LF
authors.lastname: Lopes
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001938:Brazil; D002648:Child; D002675:Child, Preschool; D020732:Cytogenetic Analysis; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007223:Infant; D015477:Leukemia, Myelomonocytic, Chronic / Q000401:mortality / Q000628:therapy*; D008297:Male; D009190:Myelodysplastic Syndromes / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome