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Cancer. 2017 Feb 1;123(3):436-448. doi: 10.1002/cncr.30257. Epub 2016 Sep 28.

The treatment of childhood acute lymphoblastic leukemia in Guatemala: Biologic features, treatment hurdles, and results.

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National Pediatric Oncology Unit, Guatemala City, Guatemala.
Francisco Marroquín Medical School, Guatemala City, Guatemala.
Department of Medicine and Surgery, Center of Biostatistics for Clinical Epidemiology, University of Milano-Bicocca, Monza, Italy.
Flow Cytometry Laboratory (Dr. Rodolfo Lorenzana), Guatemala City, Guatemala.
Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.
International Outreach Program, St. Jude Children's Research Hospital, Memphis, Tennessee.
Department of Pediatrics, University of Milano-Bicocca, Monza and Brianza Child and Mother Foundation (MBBM), San Gerardo Hospital, Monza, Italy.



The National Pediatric Oncology Unit (UNOP) is the only pediatric hemato-oncology center in Guatemala.


Patients ages 1 to 17 years with acute lymphoblastic leukemia (ALL) were treated according to modified ALL Intercontinental Berlin-Frankfurt-Münster (IC-BFM) 2002 protocol. Risk classification was based on age, white blood cell count, immunophenotype, genetics (when available), and early response to therapy.


From July 2007 to June 2014, 787 patients were treated, including 160 who had standard-risk ALL, 450 who had intermediate-risk ALL, and 177 who had high-risk ALL. The induction death rate was 6.6%, and the remission rate was 92.9%. The rates of death and treatment abandonment during first complete remission were 4.8% and 2.5%, respectively. At a median observation time of 3.6 years, and with abandonment considered an event, the 5-year event-free survival and overall survival estimates ( ± standard error) were 56.2% ± 2.1% and 64.1% ± 2.1%, respectively, with a 5-year cumulative incidence of relapse of 28.9% ± 2.0%. Twenty-one of 281 patients (7.5%) investigated were positive for the ets variant 6/runt-related transcription factor 1 (ETV6/RUNX1) fusion.


A well organized center in a low-middle-income country can overcome the disadvantages of malnutrition and reduce abandonment. Outcomes remain suboptimal because of late diagnosis, early death, and a high relapse rate, which may have a partly genetic basis. Earlier diagnosis, better management of complications, and better knowledge of ALL will improve outcomes. Cancer 2017;123:436-448. © 2016 American Cancer Society.


acute lymphoblastic leukemia; chemotherapy; childhood; low-middle-income countries; nutritional status

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