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Published on: October 17, 2025
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.
Insights
Pediatric acute lymphoblastic leukemia (ALL) survival in Mexico is lower than international rates, with 10-year survival at 58.1%. Key factors influencing relapse include older age and higher leukocyte counts.
Area of Science:
- Pediatric Oncology
- Hematology
- Clinical Research
Background:
- Survival rates for acute lymphoblastic leukemia (ALL) are significantly lower in emerging nations compared to developed countries.
- International survival rates for ALL in developed countries approach 80%.
Purpose of the Study:
- To evaluate the 10-year survival outcomes for pediatric patients diagnosed with ALL.
- To assess the effectiveness of the HP 09 protocol, adapted from the BFM 95 protocol, in a public hospital setting.
Main Methods:
- Analysis of 253 pediatric patients under 17 years old diagnosed with ALL between January 2010 and December 2020.
- Stratification of patients into standard, intermediate, and high-risk groups based on clinicobiological characteristics.
- Evaluation of 10-year overall survival (OS) and event-free survival (EFS) rates.
Main Results:
- The study reported a 10-year overall survival (OS) rate of 58.1% and an event-free survival (EFS) rate of 56.9%.
- Survival rates varied by risk group: 85.7% OS for standard-risk, 61.9% for intermediate-risk, and 41% for high-risk.
- Older age (>10 years), leukocyte count >50×10^9/L, and prior steroid exposure were significant predictors of relapse.
Conclusions:
- A significant disparity exists in pediatric ALL survival rates in Mexico compared to international standards.
- Factors contributing to this gap may include chemotherapy efficacy, disease biology, and healthcare system limitations.
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.
