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Clinical outcomes in pediatric acute lymphoblastic leukemia using modified BFM-95 protocol: 10-year study in Mexico
Karina A Solis-Labastida1, Rosa E Valdez-Avilez1, Salvador Atilano-Miguel2
1Departamento de Hematología, Unidad Médica de Alta Especialidad, Hospital de Pediatría "Dr. Silvestre Frenk Freund," Centro Médico Nacional SXXI, Instituto Mexicano del Seguro Social (IMSS), Ciudad de México, México.
Background:
Although survival rates for acute lymphoblastic leukemia (ALL) in developed countries have reached up to 80%, outcomes remain considerably lower in emerging nations. This study aimed to evaluate the 10-year survival of pediatric patients with ALL treated at a public hospital using the HP 09 protocol, adapted from the BFM 95 protocol.
Methods:
We included patients under 17 years of age diagnosed with ALL and treated with the HP 09 protocol between January 2010 and December 2020. Patients were stratified into 3 risk groups according to clinicobiological characteristics.
Results:
A total of 253 patients were analyzed. The cohort demonstrated a 10-year overall survival (OS) rate of 58.1% (90.4 ± 4.8 months) and an event-free survival (EFS) rate of 56.9% (78.2 ± 5.0 months). By risk group, the 10-year OS was 41% in the high-risk group, 61.9% in the intermediate-risk group, and 85.7% in the standard-risk group. Corresponding 10-year EFS rates were 55.2%, 57.1%, and 59.7%. Cox regression analysis identified older age (>10 years; OR = 2.11, 95% CI = 1.36 to 3, P = .001), leukocyte count >50 × 109/L (OR = 1.89, 95% CI = 1.22 to 2.93, P = .004), and prior steroid exposure before diagnosis (OR = 2.30, 95% CI = 1.16 to 4.58, P = .017) as significant predictors of relapse.
Conclusions:
This study highlights a substantial disparity in survival rates among pediatric patients with ALL in Mexico compared with international benchmarks. The gap likely reflects differences in chemotherapy efficacy, disease biology, and systemic healthcare limitations.
