Treatment of children with acute lymphoblastic leukemia in Cambodia

Abstract

We report a retrospective analysis of 110 unselected pediatric patients with acute lymphoblastic leukemia (ALL) treated during 2015–2017 in a charity‐funded public institution in Cambodia with a reduced intensity ALL‐Moscow Berlin (MB)‐91 protocol. No patient abandoned treatment. Sixty‐three patients (57%) were high risk (HR). Seventy‐two patients (65.5%) reached complete remission (CR) on day 36. The 3‐year event‐free survival (EFS) and overall survival (OS) was 34.9% (50.5% for standard risk [SR]). Most deaths resulted from infections (40 [53.3%]) and bleeding (15 [20%]). With further selective reduction of treatment intensity and access to platelet infusion, leukemia therapy is justified in this setting.

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

“…The update of the AHOPCA 2008 study documented a 5‐year EFS rate of 47.4% ± 1.2% and an OS rate of 57.3% ± 1.2%, including abandonment as an event, and rates of 53.8% ± 1.3% and 61.6% ± 1.2%, respectively, when censoring treatment abandonment (Figure 1). These results are similar to those reported from Guatemala and other LMICs 9–12 …”

“…Delayed diagnosis, malnutrition, insufficient supportive therapy, abandonment of treatment, chemotherapeutic drug shortage, poor treatment adherence, and genetic polymorphism variations may all play a role in a poor prognosis 3–7 . However, numerous efforts have been made to improve the prognosis of ALL in LMICs 2,8–12 …”

“…[3][4][5][6][7] However, numerous efforts have been made to improve the prognosis of ALL in LMICs. 2,[8][9][10][11][12] In Central America, the Monza International School of Pediatric Hematology-Oncology and St Jude Children's Research Hospital's Department of Global Pediatric Medicine (St Jude Global) have contributed to the growth of pediatric oncology over the last 25 years, with pediatric hemato-oncology centers joining together to form the Pediatric Hematology-Oncology Association of Central America (AHOPCA). [13][14][15] Costa Rica, El Salvador, Honduras, Nicaragua, and Panama conducted a cooperative study (AHOPCA-ALL 2008) for the treatment of ALL, which was based on Berlin-Frankfurt-Munster (BFM) regimens and adapted to the local situation, combining evidence-based criteria with adaptations based on feasibility.…”

“…These results are similar to those reported from Guatemala and other LMICs. [9][10][11][12] Relapse protocols in Europe and North America have demonstrated that B-cell precursor ALL with bone marrow relapses occurring later than 6 months after stopping therapy and extramedullary relapses of ALL have survival rates >70% without bone marrow transplantation. [16][17][18][19] The management of relapses in LMICs where intensive therapies, expensive new therapies like blinatumomab, measurable residual disease monitoring, and bone marrow transplantation are not available remains a challenge.…”

Genetic characteristics and treatment outcome in infants with KMT2A germline B‐cell precursor acute lymphoblastic leukemia: Results of MLL‐Baby protocol

“…From the outset, the declared goal was to avoid drugs that cause unnecessary toxicity, severe and long‐lasting BM aplasia, and undesirable late effects. The protocol contains only moderate‐dose anthracyclines, no etoposide, no cyclophosphamide, and neither high‐dose ARA‐C nor high‐dose MTX 36 . Compared to a contemporary BFM study, toxicity was shown to be significantly lower with similar results 19,35 …”