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Updated: Apr 19, 2026
Murine Model of Leukemia Relapse to Induction Chemotherapy for Acute Lymphoblastic Leukemia
Published on: October 17, 2025
Identifying causes of variability in outcomes in children with acute lymphoblastic leukemia treated in a
Wasil Jastaniah1, Naglla Elimam, Khalid Abdalla
1Princess Noorah Oncology Center, King Saud Bin Abdulaziz University and King Abdulaziz Medical City, Jeddah, Saudi Arabia; Department of Pediatrics, Faculty of Medicine, Umm AlQura University, Makkah, Saudi Arabia.
Insights
Children with acute lymphoblastic leukemia (ALL) in developing countries had lower survival rates despite treatment modifications. Further interventions are needed to reduce early deaths in these regions.
Area of Science:
- Pediatric Oncology
- Hematology
- Clinical Trials
Background:
- Outcomes for pediatric acute lymphoblastic leukemia (ALL) are poorer in developing nations due to resource limitations.
- This study investigated if therapeutic outcomes differ in resource-rich developing countries compared to industrialized regions.
- Hypothesized similar outcomes in resource-rich developing countries and industrialized regions.
Purpose of the Study:
- To evaluate the therapeutic outcomes of children with acute lymphoblastic leukemia (ALL) treated with modified protocols in a developing country.
- To compare survival rates with those reported in major international clinical trials.
- To identify areas for intervention to improve outcomes.
Main Methods:
- Retrospective analysis of 224 children with ALL treated between 2001-2007.
- Utilized modified Children's Cancer Group (CCG) protocols (CCG-1961 and CCG-1991) for standard-risk (SR) and high-risk (HR) patients.
- Included dexamethasone substitution for prednisone in HR patients and additional intrathecal methotrexate for CNS2 patients.
Main Results:
- Achieved 98.1% remission rate, with five-year overall survival (OS) of 84.7%, event-free survival (EFS) of 77.0%, and disease-free survival (DFS) of 81.4%.
- Induction failure was 1.9%, relapse rate was 15.1%, and death as the first event was 6.4%.
- Observed a significant reduction in induction deaths over time, indicating treatment improvements.
Conclusions:
- While remission rates were high, survival outcomes were lower than those in major international trials.
- Highlights the need for targeted interventions to decrease early mortality in developing regions.
- Suggests ongoing efforts are crucial to bridge the gap in pediatric ALL care globally.
Background:
The outcome of children with acute lymphoblastic leukemia (ALL) in developing countries is less favorable than in developed countries, primarily due to resource constraints. However, it is unknown whether the therapeutic results differ. Thus, we hypothesized that outcomes in resource-rich developing countries would be similar to those in industrialized regions.
Procedure:
We performed a retrospective analysis of 224 consecutive children with ALL, who were treated according to the Children's Cancer Group (CCG) protocols between January 2001 and December 2007. High-risk (HR) and standard-risk (SR) patients were treated with modified CCG-1961 and CCG-1991 protocols, respectively. Modifications included substitution of dexamethasone for prednisone in HR patients and addition of two intrathecal methotrexate treatments for CNS2 patients during induction. All patients received double delayed intensification with two interim maintenance phases.
Results:
Five-year overall survival (OS), event-free survival (EFS) and disease-free survival (DFS) were 84.7 ± 2.4%, 77.0 ± 2.9%, and 81.4 ± 2.7%, respectively. Remission was achieved in 98.1% of the patients. Induction failure and relapse rates were 1.9% and 15.1%, respectively. Death as the first event occurred in 6.4% of cases, of which 2.7% and 3.7% involved deaths in induction and remission, respectively. Interestingly, a significant reduction in induction deaths was observed over time.
Conclusions:
Despite the encouraging results observed in the present study, our patients displayed significantly lower survival outcomes compared to subjects treated in major clinical trials conducted by leading leukemia cooperative groups. Furthermore, this work underscores the need for targeted interventions to reduce death as the first event in developing regions.
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