Pediatric Acute Lymphoblastic Leukemia: Clinical Characteristics, Treatment Outcomes, and Prognostic Factors: 10 Years' Experience From a Low- and Middle-Income Country

Ahmad, Ishfaq; Ghafoor, Tariq; Ullah, Atta; Naz, Shaista; Muhammad, Tahir; Ahmed, Shakeel; Arshad, Awais; Ali, Asghar; Khattack, Tariq Azam; Fatima, Batool

doi:10.1200/go.22.00288

Cited by 5 publications

(6 citation statements)

References 20 publications

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“…Also, patient dropout and treatment abandonment have been traditionally higher in Pakistan because of lack of finances, lost wages, and lack of social support. 27 Relapse rate in our study was 48.6%, which is higher than the documented relapse risk from Western data (30%-40%). 28,29 The possible reasons are lack of IHC on most samples resulting in missing out on high-grade B-cell lymphoma, nonavailability of rituximab in large number of patients, and use of CT scan for remission assessment after treatment.…”

Section: Discussioncontrasting

confidence: 68%

Real-World Challenges of Managing Diffuse Large B-Cell Lymphoma in a Developing Country

Iftikhar,

Ahmad,

Haider

et al. 2024

JCO Glob Oncol

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PURPOSE To highlight challenges and cancer care disparities in patients of diffuse large B-cell lymphoma management in resource-constrained settings. MATERIALS AND METHODS This multicenter retrospective study included 738 patients from 12 public and private sector hematology-oncology centers across Pakistan. Patients were divided into limited-resource and enhanced-resource settings as per national diffuse large B-cell lymphoma (DLBCL) guidelines. RESULTS The median age at diagnosis was 47 years (range, 14-89). Male:female ratio was 2.5:1. Majority of the patients (69.3%) were treated in limited-resource settings. Computed tomography was used as a staging modality in 442 (60%) patients. Limited-stage DLBCL was present in 13.5% of patients, while 86.3% had advanced-stage disease at diagnosis. First-line regimens included rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone in 56% and cyclophosphamide, doxorubicin, vincristine, prednisone in 34% of patients, while 10% of patients received palliative regimens upfront. Of evaluable data, complete remission was documented in 299 (74.4%) patients, 39 (9.8%) had partial response and 63 (13.5%) had progressive disease. Disease-free survival (DFS) and overall survival (OS) status were not available for 345 (46.8%) patients at the time of data collection. Overall study cohort had a median follow-up of 2.2 years with a median OS of 3.6 years (95% CI, 3.1 to 4.1), median DFS of 3.1 years (95% CI, 2.6 to 3.6), and a 5-year OS of 40% and DFS of 36%. CONCLUSION Patients from low- and middle-income countries present at an earlier age and have more advanced disease. Patients were frequently lost to follow-up, and record keeping was inadequate more so in patients treated in limited-resource settings. There is a need to establish a national lymphoma registry, improve record keeping, and standardize treatments to ensure improvement in treatment outcomes.

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Section: Discussioncontrasting

confidence: 68%

Real-World Challenges of Managing Diffuse Large B-Cell Lymphoma in a Developing Country

Iftikhar,

Ahmad,

Haider

et al. 2024

JCO Glob Oncol

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“…At the same time, other criteria, like time to relapse or location of relapse, are important factors for survival with B-ALL [13]. Similar studies in low-and middle-income countries found the age, gender, and initial WBC count to be prognostic markers for ALL in children [14]. In a separate study, children below 15 years had a very good prognosis with ALL (the survival rate exceeded 85%), which got worse with age.…”

Section: Initial Treatmentmentioning

confidence: 99%

Major Reasons for Hospitalization to Icu of Children With Acute Lymphoblastic Leukemia: A Literature Review

Kurakbayev,

Turdaliyeva,

Umbetov

et al. 2023

Onkol. radiol. Kaz.

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Relevance: Acute lymphoblastic leukemia (ALL) is a common malignancy in children. Approximately 85% of ALLs have B-cell origin, and 15% are T-cell ALLs. Many patients diagnosed with hematologic cancer will require hospitalization in the intensive care unit (ICU) at some point in their treatment. The aim was to study the available literature on clinical deterioration in patients with АLL admitted to the ICU, the clinical significance and prognostic value of causes of clinical deterioration, and adverse outcomes in patients with АLL staying in the ICU. Methods: A descriptive cross-sectional study approach was used. We reviewed published sources from 2016 to 2023 to collect data on major reasons for ALL patients’ hospitalization to ICU. Results: First, the patient’s age at the time of initial diagnosis of ALL is crucial. Cure rates for B-cell ALL are higher between 1 and 9 years of age than in other age groups. Second, the initial white blood cell count during diagnosis is a prognostic indicator. Third, the specific subtype of ALL also affects prognosis. The risk factors emphasize the importance of comorbidities and infectious diseases, as well as monitoring and managing pulmonary and cardiovascular function in patients to avoid hospitalization in the ICU. The main causes of hospitalization in the ICU are complications related to chemotherapy, infection, and unplanned hospitalizations. Compared to normal-risk patients, high-risk patients had a higher rate of OIT hospitalization in the ICU. It is important to control chemotherapy and infections to reduce the number of admissions to the ICU in this group. Conclusion: Chemotherapy, concomitant and infectious diseases, hypoxia, and hemodynamic instability are reasons for hospitalization of these patients to ICU. The condition of various organs and systems shall be monitored.

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“…Although 80% of newly diagnosed, pediatric cancer cases worldwide occur in LMICs, their outcomes are suboptimal for various reasons compared to those in high-income countries (HICs) [99]. Factors such as the inability to access cancer care facilities; delays in initiating treatment after symptom onset; discontinuation of treatment, such as maintenance therapy, especially in the outpatient setting; and inadequate supportive care have been identified as responsible for decreased overall survival in patients with pediatric ALL [100,101]. Many LMICs have limited resources for laboratory and radiological diagnostic equipment, which hinders or delays the accurate diagnosis of pediatric malignancies including ALL [102].…”

Section: Management Of All In Low-and Middle-income Countriesmentioning

confidence: 99%

Treatment of Pediatric Acute Lymphoblastic Leukemia: A Historical Perspective

Hayashi,

Makimoto,

Yuza

2024

Cancers

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Acute lymphoblastic leukemia (ALL) is the most common disease in pediatric oncology. The history of developmental therapeutics for ALL began in the 1960s with the repetition of “unreliable” medical interventions against this lethal disease. By the 1990s, the development of multi-agent chemotherapy and various types of supportive care rendered ALL treatable. Highly sophisticated, molecular, diagnostic techniques have enabled highly accurate prediction of the relapse risk, and the application of risk-adapted treatments has increased the survival rate in the standard-risk group to nearly 100% in most European nations and North America. Incorporation of state-of-the-art, molecularly targeted agents and novel treatments, including cell and immunotherapy, is further improving outcomes even in the high-risk group. On the other hand, the financial burden of treating children with ALL has increased, imperiling the availability of these diagnostic and treatment strategies to patients in low- and middle-income countries (LMICs). The fundamental treatment strategy, consisting of corticosteroid and classical cytotoxic therapy, has achieved fairly good outcomes and should be feasible in LMICs as well. The present review will discuss the history of developmental therapeutics for childhood ALL in various countries through an extensive literature review with the aim of proposing a model for a treatment backbone for pediatric ALL. The discussion will hopefully benefit LMICs and be useful as a base for future clinical trials of novel treatments.

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Pediatric Acute Lymphoblastic Leukemia: Clinical Characteristics, Treatment Outcomes, and Prognostic Factors: 10 Years' Experience From a Low- and Middle-Income Country

Cited by 5 publications

References 20 publications

Real-World Challenges of Managing Diffuse Large B-Cell Lymphoma in a Developing Country

Real-World Challenges of Managing Diffuse Large B-Cell Lymphoma in a Developing Country

Major Reasons for Hospitalization to Icu of Children With Acute Lymphoblastic Leukemia: A Literature Review

Treatment of Pediatric Acute Lymphoblastic Leukemia: A Historical Perspective

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