A high rate of very early, CNS, and BM relapse with a considerably low 5-year OS requiring reassessment of therapy was documented. Organomegaly at diagnosis was a highly significant clinical predictor for relapse.

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In 1963 Jean Bernard introduced the concept of “geographic hematology” and distinguished 2 branches, i.e., “ethnic hematology,” which deals with differences between populations, and “environmental hematology,” which considers factors such as food habits, infections, and others. Both of these branches have implications in the distribution of hematological diseases worldwide. In comparison with Caucasian populations, in Mexico a significantly higher prevalence of acute lymphoblastic, acute promyelocytic, and acute megakaryoblastic leukemias has been described. The rate of chronic myeloid leukemia seems to be as high as that reported in Caucasian populations, while other myeloproliferative neoplasias are significantly less frequent in Mexico. Significantly lower prevalences of hairy cell leukemia, chronic lymphocytic leukemia, multiple myeloma, and Waldenström’s macroglobulinemia have been reported from Mexico. Regrettably, the influence of drug companies interested in selling their new and expensive drugs has resulted in both overdiagnosis of some diseases and overidentification of the refractory forms of some of these conditions to justify the use of unnecessary drugs.

Hospitalizations for children with ALL were less expensive than in high-income countries but had a significant cost to low-income families and to the healthcare system.

BACKGROUND: Umbilical cord blood (UCB) represents an alternative source of stem cells for transplantation for the treatment of hematologic malignancies and genetic disorders. There is scarce information detailing cord blood bank (CBB) collection and transplantation activities from developing countries. We documented our experience at a public university hospital in northeast Mexico. STUDY DESIGN AND METHODS: We carried out a retrospective and descriptive analysis of our CBB activity during an 8‐year period from May 2002 to September 2010. Collection, processing, and cryopreservation of CB were carried out following standard operating procedures. The minimum volume and total nucleated cell (TNC) content for cryopreservation were 80 mL and 8.0 × 108, respectively. RESULTS: A total of 1256 UCB units were collected; 428 (34%) were banked and 828 (66%) were discarded. The main reason for exclusion was biologic: low volume and/or low number of TNC accounted for 84% of the total discarded units. Cryopreserved cord blood units (CBUs) had a median volume of 113.8 mL (range, 80‐213.2 mL) and 13.0 × 108 (range, 8 × 108‐36.6 × 108) TNCs. Cell viability was 99.3% (88‐100%). The median CD34+ cell content was 4.0 × 106 (0.46 × 106‐19.38 × 106). Sixteen units have been released for transplantation, leading to a utilization rate of 3.7%. CONCLUSION: CBB demands considerable human and financial resources; it is then essential for centers at developing countries to share their experience, results, and databases to increase the probability of finding matching units for their patients. Efforts to create and maintain CBBs allow to offer this therapeutic option at an affordable cost.

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access to quality care for children with leukemia before the COVID-19 pandemic was already disadvantaged, with 5-year survival rates of 40%-60% compared to 90%-95% in developed countries. 1,2 Thus, safeguarding care of acute lymphoblastic leukemia (ALL) patients during the COVID-19 pandemic has represented a challenge.We analyzed 553 visits from 89 patients with ALL in "Hospital Universitario Dr. José Eleuterio Gonzalez." We conventionally administer all chemotherapy in an outpatient backbone. Some of the strategies implemented were increasing the capacity of infusion beds, offering telemedicine follow-up 24/7, continuing with the transplant program with outpatient intent, providing social support, and partnering with non-governmental organizations to assist families in paying for chemotherapy when needed. In our center, we did not modify or reduced intensity of the chemotherapy regimen. In addition, SARS-Cov-2-positive patients in induction received Capizzi chemotherapy regimen.Chemotherapy administration was timely and performed as per the protocol in 83% (n = 459) of the records reviewed. However, adherence was lower during the consolidation and intermediate maintenance phases (60.9% and 64%) and was associated with a shortage of cytarabine and methotrexate.The main causes of treatment delays were lack of financial resources (2.45), lack of inpatient beds (1.8%), and chemotherapy stock-outs (1.3%). In addition, the treatment abandonment rate was 3.3%.Other centers in low-and middle-income countries have reported their challenges during the pandemic, including missed or delayed diagnosis, chemotherapy shortages, shortfall of blood products, 3 and closure of HSCT programs. 2,4 Also, Gratz et al. reported decreased financial support, reduced clinical staff, and decreased available beds.The lack of availability of inpatient beds in our center was overcome by providing an ambulatory treatment regimen. If the treatment delay was >5 days, the 6-h outpatient infusion of methotrexate was implemented for low and intermediate risk. 5 During this time, 22 patients (24.7%) had a positive PCR test for SARS-CoV2; the median age was 5 years (range, 0.9-15). Two patients (9%) were diagnosed with COVID-19 and ALL simultaneously, eight patients (36%) during intensive phases of treatment, and ten (45%) with extended maintenance. In addition, two patients were diagnosed after haploidentical HSCT.The incidence of COVID-19 in our series was 24.7%, while other LA centers reported 13.1% and 58%. 6,7 Our mortality rate was 4.5%, similar to the global registry of Covid reported 8 ; however, another group in LA reported up to 37%. 6 Critical or severe illness was classified in 18%.Seven patients (32%) developed pneumonia, and two (9%) had multisystem inflammatory syndrome. Five (22.7%) required oxygen support, and two (9%) required mechanical ventilation. Three patients (13.6%) currently have late sequelae.The additional support interventions in our center allowed the continuity of ALL treatment for >80%. However, our high rate of abando...

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