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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.

Author information

1
National Pediatric Oncology Unit, Guatemala City, Guatemala.
2
Francisco Marroquín Medical School, Guatemala City, Guatemala.
3
Department of Medicine and Surgery, Center of Biostatistics for Clinical Epidemiology, University of Milano-Bicocca, Monza, Italy.
4
Flow Cytometry Laboratory (Dr. Rodolfo Lorenzana), Guatemala City, Guatemala.
5
Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.
6
International Outreach Program, St. Jude Children's Research Hospital, Memphis, Tennessee.
7
Department of Pediatrics, University of Milano-Bicocca, Monza and Brianza Child and Mother Foundation (MBBM), San Gerardo Hospital, Monza, Italy.

Abstract

BACKGROUND:

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

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

KEYWORDS:

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

PMID:
27683100
DOI:
10.1002/cncr.30257
[Indexed for MEDLINE]
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