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. 2023 Mar 1;129(5):771-779.
doi: 10.1002/cncr.34572. Epub 2022 Dec 12.

How should childhood acute lymphoblastic leukemia relapses in low-income and middle-income countries be managed: The AHOPCA-ALL study group experience

Darrell Espinoza  1 , Jessica G Blanco Lopez  2 , Roberto Vasquez  3 , Ligia Fu  4 , Roxana Martínez  5 , Hilze Rodríguez  6 , Marta Navarrete  7 , Scott C Howard  8 , Paola Friedrich  9 , Maria Grazia Valsecchi  10 , Valentino Conter  11 , Francesco Ceppi  12
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Free article

How should childhood acute lymphoblastic leukemia relapses in low-income and middle-income countries be managed: The AHOPCA-ALL study group experience

Darrell Espinoza et al. Cancer. .
Free article

Abstract

Background: Children with relapsed acute lymphoblastic leukemia (ALL) in low-income 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.

Keywords: acute lymphoblastic leukemia; children; clinical trial; low-income countries; relapse.

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References

REFERENCES

    1. Metzger ML, Howard SC, Fu LC, et al. Outcome of childhood acute lymphoblastic leukaemia in resource-poor countries. Lancet. 2003;362(9385):706-708. doi:10.1016/s0140-6736(03)14228-6
    1. Rodriguez-Galindo C, Friedrich P, Alcasabas P, et al. Toward the cure of all children with cancer through collaborative efforts: pediatric oncology as a global challenge. J Clin Oncol. 2015;33(27):3065-3073. doi:10.1200/jco.2014.60.6376
    1. Ceppi F, Antillon F, Pacheco C, et al. Supportive medical care for children with acute lymphoblastic leukemia in low- and middle-income countries. Expert Rev Hematol. 2015;8(5):613-626. doi:10.1586/17474086.2015.1049594
    1. Gupta S, Antillon FA, Bonilla M, et al. Treatment-related mortality in children with acute lymphoblastic leukemia in Central America. Cancer. 2011;117(20):4788-4795. doi:10.1002/cncr.26107
    1. Perez-Andreu V, Roberts KG, Harvey RC, et al. Inherited GATA3 variants are associated with Ph-like childhood acute lymphoblastic leukemia and risk of relapse. Nat Genet. 2013;45(12):1494-1498. doi:10.1038/ng.2803

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