Treatment strategies and regimens of graduated intensity for childhood acute lymphoblastic leukemia in low-ioncome countries

A proposal

Stephen P. Hunger, Lillian Sung, Scott Howard

Research output: Contribution to journalReview article

55 Citations (Scopus)

Abstract

Cure rates for children with acute lymphoblastic leukemia (ALL) are 80-85% in high-income countries (HICs) in North America and Western Europe. However, cure rates are much lower in many low- income countries (LICs), where most cases of ALL occur. Over the past several decades partnerships ("twinning") between HIC and LIC pediatric oncology programs have led to major improvements in outcome for children with ALL in some LICs, often by developing time and resource intensive relationships that allow LIC centers to treat children with regimens similar or identical to those used in HICs. However, the resources are not available in most LICs to allow immediate introduction of intensive ALL treatment regimens similar to those used in HICs. With these thoughts in mind, we present a proposal for a systematic and graduated approach to ALL diagnosis, risk classification, and treatment in LICs. We have based the strategy and the proposed regimens on those developed by the Children's Cancer Group (CCG) and Children's Oncology Group (COG) over the past several decades, beginning with a first level regimen similar to CCG therapy of the early 1980s and then layering on successive treatment intensifications proven effective in randomized clinical trials. Simple monitoring rules are included to help centers decide when they are ready to add new treatment components. This proposal provides a framework that LIC centers can use to provide effective ALL therapy, particularly in regions of the world where few children are currently being cured.

Original languageEnglish (US)
Pages (from-to)559-565
Number of pages7
JournalPediatric Blood and Cancer
Volume52
Issue number5
DOIs
StatePublished - May 1 2009
Externally publishedYes

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Precursor Cell Lymphoblastic Leukemia-Lymphoma
Therapeutics
Group Psychotherapy
North America
Developing Countries
Neoplasms
Randomized Controlled Trials
Pediatrics

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology

Cite this

Treatment strategies and regimens of graduated intensity for childhood acute lymphoblastic leukemia in low-ioncome countries : A proposal. / Hunger, Stephen P.; Sung, Lillian; Howard, Scott.

In: Pediatric Blood and Cancer, Vol. 52, No. 5, 01.05.2009, p. 559-565.

Research output: Contribution to journalReview article

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