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Murine Model of Leukemia Relapse to Induction Chemotherapy for Acute Lymphoblastic Leukemia
Published on: October 17, 2025
Outcome of children treated for relapsed acute lymphoblastic leukemia in Central America
Stacey Marjerrison1, Federico Antillon, Ligia Fu
1Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Survival outcomes for childhood acute lymphoblastic leukemia (ALL) relapse in Central America are poor. However, children with favorable risk factors can achieve prolonged survival without stem cell transplantation.
Area of Science:
- Pediatric Oncology
- Hematologic Malignancies
- Global Health Disparities
Background:
- Outcomes for relapsed childhood acute lymphoblastic leukemia (ALL) in resource-limited settings are largely undocumented.
- This study addresses the survival of children with ALL relapse in Central America.
Purpose of the Study:
- To examine survival rates after relapse in children with ALL in Central America.
- To identify predictors of event-free survival (EFS) and overall survival (OS) post-relapse.
Main Methods:
- Retrospective cohort study of 755 children with first ALL relapse in Guatemala, Honduras, or El Salvador (1990-2011).
- Analysis of predictors for subsequent EFS and OS.
Main Results:
- Median time to relapse was 1.7 years; most relapses occurred during or after maintenance chemotherapy, primarily in bone marrow.
- Subsequent 3-year EFS was 22.0% and OS was 28.2%.
- Favorable risk factors included younger age, lower white blood cell count, isolated CNS or testicular relapse, and relapse >36 months from diagnosis. A favorable risk group had 3-year EFS of 50.0% and OS of 68.0%.
Conclusions:
- Prognosis for relapsed ALL in Central America is poor, but a subset with favorable risk features can achieve prolonged survival.
- Risk stratification is crucial for guiding therapeutic decisions, even without access to stem cell transplantation.
Background:
Outcomes for relapsed childhood acute lymphoblastic leukemia (ALL) have not been documented in resource-limited settings. This study examined survival after relapse for children with ALL in Central America.
Methods:
A retrospective cohort study was performed and included children with first relapse of ALL in Guatemala, Honduras, or El Salvador between 1990 and 2011. Predictors of subsequent event-free survival (EFS) and overall survival (OS) were examined.
Results:
There were 755 children identified with relapsed disease. The median time from diagnosis to relapse was 1.7 years (interquartile range, 0.8-3.1 years). Most relapses occurred during (53.9%) or following (24.9%) maintenance chemotherapy, and the majority occurred in the bone marrow (63.1%). Following the initial relapse, subsequent 3-year EFS (± standard error) and OS were 22.0% ± 1.7%, and 28.2% ± 1.9%, respectively. In multivariable analysis, worse postrelapse survival was associated with age ≥ 10 years, white blood cell count ≥ 50 × 10(9) /L, and positive central nervous system status at the original ALL diagnosis, relapse that was not isolated central nervous system or testicular, and relapse < 36 months following diagnosis. Site and time to relapse were used to identify a favorable risk group whose 3-year EFS and OS were 50.0% ± 8.9% and 68.0% ± 8.1%, respectively.
Conclusions:
Prognosis after relapsed ALL in Central America is poor, but a substantial number of those with favorable risk features have prolonged survival, despite lack of access to stem cell transplantation. Stratification by risk factors can guide therapeutic decision-making. Cancer 2013. © 2012 American Cancer Society.
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