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Arch Med Res. 2016 Nov;47(8):668-676. doi: 10.1016/j.arcmed.2017.01.004.

Results of Treating Childhood Acute Lymphoblastic Leukemia in a Low-middle Income Country: 10 Year Experience in Northeast Mexico.

Author information

1
Departamento de Hematología, Hospital Universitario Dr. José Eleuterio González, Facultad de Medicina, de la, Universidad Autónoma de Nuevo León, Monterrey, México. Electronic address: carjaime@hotmail.com.
2
Departamento de Hematología, Hospital Universitario Dr. José Eleuterio González, Facultad de Medicina, de la, Universidad Autónoma de Nuevo León, Monterrey, México.

Abstract

BACKGROUND AND AIMS:

In high-income countries, treatment protocols for acute lymphoblastic leukemia (ALL) in children lead to a 5-year overall survival (OS) approaching 90%. There is scarce information on protocols and results of therapy from low-middle income countries (LMIC). We documented the results of treating children with ALL with two protocols in consecutive 5-year periods at a reference center in northeast Mexico.

PATIENTS AND METHODS:

Children ≤16 years of age diagnosed with ALL treated with two protocols were studied. Each protocol was used for 5 years; 246 children, 112 in protocol 1 and 134 in protocol 2, were included. Protocols were BFM-inspired and adapted from several regimens; protocol 2 was intended to decrease toxicity and need for hospitalization. Event-free survival (EFS) and overall survival (OS) were determined using the Kaplan-Meier method.

RESULTS:

In protocol 1, 103 patients (91.96%) achieved complete remission compared to 106 (79.10%) in protocol 2 (p = 0.001). The 5-year OS was 67.1% for protocol 1 vs. 55.5% for protocol 2, whereas EFS was 58.2% vs. 36.9%, respectively. Relapse occurred in 45 patients (40.17%) in protocol 1 vs. 42 (31.34%) in protocol 2 (p = 0.181). OS 1 year after relapse was 52.4% vs. 57.1%, respectively. No difference in relapse rate was documented.

CONCLUSIONS:

No improvement in survival rates of children with ALL from a low-income group living in a LMIC was achieved over a decade. Implementation of contemporary protocols with a high success rate is mandatory.

KEYWORDS:

Acute lymphoblastic leukemia; Chemotherapy; Childhood leukemia; Low-middle income countries; Survival rates

PMID:
28476194
DOI:
10.1016/j.arcmed.2017.01.004
[Indexed for MEDLINE]

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