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

Abstract

Background: Children with relapsed acute lymphoblastic leukemia (ALL) in lowincome 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.

The genetic risk of acute lymphoblastic leukemia and its implications for children of Latin American origin

“…Higher rates of relapse in Hispanic/Latino ALL patients in the United States and in Latin American countries contribute to their inferior OS and EFS (43)(44)(45). The causes of the differential survival rates of ALL patients among Hispanic/Latino populations are, however, complex and multifactorial.…”