Treatment of childhood acute lymphoblastic leukemia in central America: A lower-middle income countries experience

Background Five Asociación de Hemato‐Oncología de Centroamérica (AHOPCA) countries have used an adapted BFM‐based protocol for childhood acute lymphoblastic leukemia (ALL). Procedure In the AHOPCA‐ALL 2008 protocol, patients were stratified by age, white blood cell count, immunophenotype, central ne...

Full description

Saved in:

Bibliographic Details
Published in:	Pediatric blood & cancer Vol. 61; no. 5; pp. 803 - 809
Main Authors:	Navarrete, M., Rossi, E., Brivio, E., Carrillo, J.M., Bonilla, M., Vasquez, R., Peña, A., Fu, L., Martinez, R., Espinoza, C.M. Pacheco, Lacayo, L.F. Baez, Rodriguez, H., Batista, R., Barr, R., Howard, S.C., Ribeiro, R.C., Masera, G., Biondi, A., Conter, V., Valsecchi, M.G.
Format:	Journal Article
Language:	English
Published:	United States Blackwell Publishing Ltd 01-05-2014 Wiley Subscription Services, Inc
Subjects:	acute lymphoblastic leukemia Adolescent Central America Child Child, Preschool childhood Combined Modality Therapy Developing Countries Female Follow-Up Studies Hematology Humans Immunophenotyping Income Infant Infant, Newborn low-middle income countries Male Neoplasm Recurrence, Local - etiology Neoplasm Recurrence, Local - mortality Neoplasm Recurrence, Local - therapy Neoplasms, Second Primary - etiology Neoplasms, Second Primary - mortality Neoplasms, Second Primary - therapy Oncology Pediatrics Poverty Precursor Cell Lymphoblastic Leukemia-Lymphoma - complications Precursor Cell Lymphoblastic Leukemia-Lymphoma - mortality Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy Prognosis Remission Induction Survival Rate Withholding Treatment - economics Withholding Treatment - statistics & numerical data Central America childhood low-middle income countries acute lymphoblastic leukemia
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Background Five Asociación de Hemato‐Oncología de Centroamérica (AHOPCA) countries have used an adapted BFM‐based protocol for childhood acute lymphoblastic leukemia (ALL). Procedure In the AHOPCA‐ALL 2008 protocol, patients were stratified by age, white blood cell count, immunophenotype, central nervous system involvement, day 8 prednisone response, and morphologic bone marrow response to induction therapy. Patients at Standard Risk (SR) received a three‐drug induction regimen, a reinduction phase, and maintenance with protracted intrathecal therapy. Those at Intermediate (IR) and High Risk (HR) received, in addition, daunorubicin during induction therapy, a consolidation phase and two or three reinduction phases respectively. Results From August 2008 through July 2012, 1,313 patients were enrolled: 353 in SR, 548 in IR, 412 in HR. During induction therapy, 3.0% of patients died, 2.7% abandoned treatment, 1.1% had resistant ALL, and 93.2% achieved morphological complete remission (CR). Deaths and abandonment in first CR occurred in 2.7% and in 7.0% of patients, respectively. The relapse rate at a median observation time of 2.1 years was 15.0%. At 3 years, the event‐free survival (EFS) and overall survival (OS), with abandonment considered as an event, were 59.4% (SE 1.7) and 68.2% (SE 1.6). Three‐year EFS was 68.5% (SE 3.0), 62.1% (SE 2.6), and 47.8% (SE 3.2) for SR, IR, and HR groups. Adolescents had a significantly higher relapse rate (P = 0.001). Conclusions This experience shows that common international studies are feasible in lower‐middle income countries. Toxic deaths, abandonment of treatment, and relapses remain major obstacles to the successful treatment. Alternative treatment strategies may be beneficial. Pediatr Blood Cancer 2014;61:803–809. © 2013 Wiley Periodicals, Inc.
Bibliography:	ark:/67375/WNG-B5QBGH80-B istex:011E07D6CA2DE81990EF7A10FAFBC0692A46733B ArticleID:PBC24911
ISSN:	1545-5009 1545-5017
DOI:	10.1002/pbc.24911