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The Impact of Socioeconomic Factors on the Outcome of Childhood Acute Lymphoblastic Leukemia (ALL) Treatment in a Low/Middle Income Country (LMIC)

Jabeen, Kishwer MBBS; Ashraf, Mohammed S. MD, MBBS, DCH, MCPS, FCPS, MRCPI; Iftikhar, Sundus MS; Belgaumi, Asim F. MD

Journal of Pediatric Hematology/Oncology: November 2016 - Volume 38 - Issue 8 - p 587–596
doi: 10.1097/MPH.0000000000000653
Original Articles

Survival for childhood acute lymphoblastic leukemia (ALL) has improved significantly, but these benefits may not be available to many children from low and middle income countries, where reasons for treatment failure may be unique to their environment. We retrospectively reviewed data on pediatric (1 to 18 y or younger) patients with newly diagnosed ALL treated over 5 years at a children’s cancer hospital in Pakistan. Patients were treated with modified Berlin-Frankfurt-Muenster -based therapy without risk stratification. There were 255 children with a median age of 7 years (mean, 7.65 y) and a male preponderance (M:F=1.6:1). 20% had T-ALL, one-third had white blood cells >50×109/L and 13.7% central nervous system disease. A majority (56.5%) was malnourished. In total, 49 (19.2%) died before the end of induction and 21 died in complete remission. Most deaths were infection-related. A total of 50 patients relapsed and 19 abandoned therapy after complete remission. Five-year overall survival is 52.9% with abandonment censored and 45.8% with abandonment as an event. Overall survival was related to socioeconomic status but not to known risk factors. The outcome of ALL at our center is suboptimal and associated with factors not commonly seen in developed countries. Special attention to early diagnosis, infection control, and parental educational are needed to improve the survival.

*Indus Children’s Cancer Hospital, Karachi, Pakistan

Sidra Medical and Research Center

Weill Cornell Medical College – Qatar, Cornell University, Doha, Qatar

The authors declare no conflict of interest.

Reprints: Kishwer Jabeen, MBBS, Indus Children Cancer Hospital, ST-1/C Block 10, Ayesha Manzil, F.B Area, Karachi, Pakistan (e-mail:

Received December 1, 2015

Accepted June 24, 2016

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.