Treatment outcomes of children with acute lymphoblastic leukemia in a middle-income developing country: high mortalities, early relapses, and poor survival (original) (raw)
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Outcome of Childhood Acute Lymphoblastic Leukemia in Jordan
leukemia (ALL) in low- and middle-income countries are lacking. Our study is designed to assess survival of childhood ALL at King Hussein Cancer Center (KHCC) using modified St. Jude Children’s Research Hospital protocols. Patients and methods. We reviewed the medical records of children 1–18 years of age who were diagnosed with ALL and treated at KHCC from January 2003 through December 2009. Disease characteristics and outcome were analyzed. Results. Over a 7-year period, 300 children with ALL were treated. One hundred and seventy-three (57.7%) were males and 127 (42.3%) were females. The median age at diagnosis was 5 years. One hundred and fifty-seven (52.3%) children were classified as low-risk, 118 (39.3%) were standard-risk and 25 (8.3%) were high-risk. Two hundred and sixty-two (88.5%) children had pre-B cell phenotype and 34 (11.5%) had Tcell phenotype. Two hundred and seventy-three (91.3%) children were classified as having CNS I disease, 24 (8%) had CNS II, and 2 (0.67%) had CNS III. Cytogenetic abnormalities included: t(12;21) in 30 (12%) children and t(9;22) in 18 (7.4%). Four (1.3%) children died in induction, 6 (2%) died in first remission and 27 (9%) relapsed. After a median follow-up of 34.5 months (range 0.32– 84.5), the estimated 5-year event free survival and overall survival were 80% and 89%, respectively. Conclusion. Treatment protocols developed by major cooperative groups and institutions to treat childhood ALL was successfully adapted and suggest that such an approach may be useful in other low- and middle-income countries.
Journal of Pediatric Hematology/Oncology, 2016
Survival for childhood acute lymphoblastic leukemia (ALL) has improved significantly, but these benefits may not be available to many children from low and middle income countries, where reasons for treatment failure may be unique to their environment. We retrospectively reviewed data on pediatric (1 to 18 y or younger) patients with newly diagnosed ALL treated over 5 years at a children's cancer hospital in Pakistan. Patients were treated with modified Berlin-Frankfurt-Muenster-based therapy without risk stratification. There were 255 children with a median age of 7 years (mean, 7.65 y) and a male preponderance (M:F = 1.6:1). 20% had TALL , one-third had white blood cells >50Â10 9 /L and 13.7% central nervous system disease. A majority (56.5%) was malnourished. In total, 49 (19.2%) died before the end of induction and 21 died in complete remission. Most deaths were infection-related. A total of 50 patients relapsed and 19 abandoned therapy after complete remission. Five-year overall survival is 52.9% with abandonment censored and 45.8% with abandonment as an event. Overall survival was related to socioeconomic status but not to known risk factors. The outcome of ALL at our center is suboptimal and associated with factors not commonly seen in developed countries. Special attention to early diagnosis, infection control, and parental educational are needed to improve the survival.
Acute lymphoblastic leukemia in low and middle-income countries
Current Opinion in Oncology, 2014
Acute lymphoblastic leukemia is the most common pediatric cancer. The cure rate of this disease is over 80% in developed countries utilizing protocols with very tolerable toxicity. Several factors contributed to this success, including the implementation of large collaborative clinical trials and the better understanding of disease biology allowing for risk-stratified treatment. We will review the current state of the treatment of acute lymphoblastic leukemia in low-income and medium-income countries.
Cancer, 2022
Abstract Background: Children with relapsed acute lymphoblastic leukemia (ALL) in lowincome and middle‐income countries rarely survive. The Pediatric Hematology‐ Oncology Association of Central America (AHOPCA) developed the AHOPCA‐ALL REC 2014 protocol to improve outcomes in resource‐constrained settings without access to stem cell transplantation. Methods: The AHOPCA‐ALL REC 2014 protocol was based on a modified frontline induction phase 1A, a consolidation therapy with six modified R‐blocks derived from the ALL–Berlin‐Frankfurt‐Munster REZ 2002 protocol and intermittent maintenance therapy. Children with B‐lineage ALL were eligible after a late medullary relapse, an early or late combined relapse, or any extramedullary relapses. Those with T‐lineage ALL were eligible after early and late extramedullary relapses, as were those with both B‐lineage and T‐lineage relapses occurring at least 3 months after therapy abandonment. Results: The study population included 190 patients with T‐lineage (n = 3) and B‐lineage (n = 187) ALL. Of those with B‐lineage ALL, 25 patients had a very early extramedullary relapse, 40 had an early relapse (32 extramedullary and 8 combined), and 125 had a late relapse (34 extramedullary, 19 combined, and 72 medullary). The main cause of treatment failure was second relapse (52.1%). The 3‐year event‐free survival rate (± standard error) was 25.9% ± 3.5%, and the 3‐year overall survival rate was 36.7% ± 3.8%. The 3‐year event‐free survival rate was 47.2% ± 4.7% for late relapses. The most frequently reported toxicity was grade 3 or 4 infection. Mortality during treatment occurred in 17 patients (8.9%), in most cases because of infectious complications. Conclusions: Selected children with relapsed ALL in Central America can be cured with second‐line regimens even without access to consolidation with stem cell transplantation. Children in low‐income and middle‐income countries who have lower risk relapses of ALL should be treated with curative intent.
Bali Medical Journal, 2022
Introduction: The cure rate of Acute Lymphoblastic Leukemia (ALL) in low and middle-income countries is still low. Many factors contribute to relapses event, thus leading to failure of the treatment outcome. However, there are limited studies regarding the relapse of childhood cancer in Indonesia. This study determined demography, clinical, and characteristic laboratory differentiation between relapse and non-relapse in the bone marrow childhood ALL group.Methods: This was a retrospective descriptive study in children newly diagnosed with ALL ages 0-18 who completed the induction phase using the 2013 treatment protocol during the 2018 period in Pediatrics Hematology-Oncology Unit at a reference center hospital in Indonesia. Of 78 data collected from the Indonesian Pediatric Cancer Registry (IP-CAR) and Hospital Information System after excluding abandoned treatment or death during treatment, only 35 patients completed the overall therapy. We evaluated bone marrow relapse and classif...
Asian Pacific Journal of Cancer Prevention, 2019
Objective:Understanding the clinical and genetic characteristics of pediatric acute lymphoblastic leukemia (ALL) patients may help assigning the appropriate treatment. This study aims to understand patients’ characteristics, “real-world” treatment practice and outcomes of pediatric ALL. Methods:A cohort of 213 pediatric ALL patients, treated at (King Faisal Specialist Hospital and Research Center –Jeddah branch) KFSH and RC-J during the period of January 2002 to December 2015 were analyzed retrospectively. Statistical analyses were performed on patients’ demographic, clinical and genetics characteristics and outcomes of different treatment protocols. Survival was evaluated using Kaplan-Meier method, and differences in survival were tested using Log-Rank. Significance was set at 0.05 level. Results:Median age of the study cohort was 5 years (range 0.5–15 years) with 55.4% of male population. Majority of the patients had pre-B-cell ALL (88.7%), WBC count <50, 000/µL at diagnosis (76.1%, median = 13.5/µL with a range of 0.51–553.0/µL) with involvement of central nervous system (CNS) disease in 8.5%patients.Different common chromosomal anomalies or abnormalities, including t(12, 21) translocation, MLL genre arrangements, trisomy (4, 10, 17)and others, were detected. Early response to the risk-directed treatment received by the patients (91.1% achieving <5% blast in the bone marrow) as well as the end of induction outcome (96.2%) was encouraging. Conclusion:We found that the patients’ clinical characteristics and distribution of genetic abnormalities were similar to those of the western countries. Our findings show that the earlier gap between the western countries and KSA in terms of survival has been closed and that competitive outcomes can be achieved with local infrastructure.
Rates and trends of childhood acute lymphoblastic leukaemia: an epidemiology study
2020
Acute lymphoblastic leukaemia (ALL) is the most common childhood cancer and has a high survival rate when properly managed. prognosis is correlated with many factors such as age, gender, white blood cell (WBC) count, CD10, French-American-British (FAB) classification, and many others. Many of these factors are included in this study as they play a major role in establishing the best treatment protocol. this study aims to demonstrate clinical and laboratory features of childhood ALL in Syria. they were treated at children's University Hospital, the only working major cancer centre in Syria at the time of the study. Data of 203 patients who aged 0-14 years were obtained for this study. Most patients (48.8%) aged (5-9) years with a male predominance (60.9%). The major features for ALL included lymphadenopathy (82.9%), presenting with systemic symptoms (74.9%), TALL subclass (20.2%), L2 FAB classification (36.1%), low educational levels for fathers (53%) and mothers (56.2%), having a high risk (48.4%), and having a duration of symptoms before evaluation for more than 4 weeks (42.6%). Only three (1.5%) patients had normal full blood counts (FBC) and only one (0.5%) patient had an isolated high WBC count at time of presentation. Most patients had either abnormal platelet count (89.3%) or low haemoglobin level (88.8%) when presenting with only (2.0%) having normal levels for both. This suggests that having normal haemoglobin and platelet count can be used for quick screening in crisis time like in Syria for prioritising patients. Many prognostic factors were significantly different from medical literature which emphasises the importance of local studies in the developping countries. this study included a high prevalence of Tall , L2 FAB classification, high-risk and other variables which require further studies to evaluate the aetiology of these features, especially that treatment protocols may have a higher mortality in developing countries when not adjusted to local variables. Acute lymphoblastic leukaemia (ALL) is the most common cancer in childhood, with a prevalence up to 25% of cancers in children who are under the age of 15 years 1. Although ALL is curable, many parts of the world may not have access to modern treatment. Approximately eight to nine of every ten children that have ALL are considered long-term survivors and cured in developed countries, but these reults markedly differ in developping countries 2,3. These positive outcomes are due to having access to top treatments at the most advanced institutions 2. Although the five-year survival rate is 93.5% when using the newest protocols and top chemotherapy, some cases of relapse still occur 4. Nevertheless, top treatment cannot be accessed by all countries as many factors may get involved such as resource scarcity 5. Few studies were concerned with paediatric ALL in the Middle East 6. Little is known about childhood ALL in the Middle East and further studies are needed to establish standard data for future regional collaborative research as it provides a baseline for future protocols in ALL as they needed to be adjusted to the local variables. This raises a challenge as it is not easy to conduct medical research such as medical trials in developing countries due to the unavailability of porper funding and institutions which makes this quite challenging. In this article, the epidemiology and characterstics of ALL patients along with ALL variables such as prognostic risk and subtype are studied. Our study aims to define the risk factors and features associated with ALL in Syria.