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Treatment outcome in pediatric patients with T-ALL in Brazil
Ana Maria Marinho da Silva1, Valdenizia R Silva2, Alython Araújo Chung-Filho2
1Fundação Oswaldo Cruz, Fiocruz, Instituto Gonçalo Moniz, Salvador, Bahia 40296-710, Brazil; Hospital Aristides Maltez, Salvador, Bahia 40285-000, Brazil.
Insights
Pediatric T-cell acute lymphoblastic leukemia (T-ALL) survival in Brazil is lower than in high-income countries, with infection being a major cause of death. Treatment protocol adaptations are crucial for improving outcomes in low- and middle-income countries.
Area of Science:
- Pediatric Oncology
- Hematology
- Epidemiology
Background:
- Treatment intensification has improved pediatric T-cell acute lymphoblastic leukemia (T-ALL) survival in high-income countries (HICs).
- Limited data exist on T-ALL treatment outcomes in low- and middle-income countries (LMICs).
- This study examines T-ALL survival and clinical factors in Brazil's public healthcare system.
Purpose of the Study:
- To evaluate survival rates for pediatric T-cell acute lymphoblastic leukemia (T-ALL) in Brazil.
- To identify clinical factors associated with survival outcomes in T-ALL patients.
- To compare the effectiveness of different treatment protocols within the Brazilian healthcare context.
Main Methods:
- Retrospective analysis of medical records from 86 pediatric T-ALL patients (0-19 years).
- Data collected from four reference oncology centers in the Brazilian Unified Health System.
- Inclusion of clinical, demographic, and laboratory variables.
Main Results:
- Five-year overall survival (pOS) was 47% and event-free survival (pEFS) was 43.2%.
- Infection was the leading cause of death (69.4%).
- Adenomegaly at diagnosis correlated with lower survival; the GBTLI-HR protocol showed higher pOS (70.0%) compared to others.
Conclusions:
- Brazilian pediatric T-ALL patients face higher mortality rates than those in HICs.
- High infection rates significantly contribute to mortality.
- Context-specific adaptations of intensive treatment protocols are necessary for LMICs.
Background:
Several studies conducted in high-income countries (HICs) have demonstrated that treatment intensification in pediatric T-cell acute lymphoblastic leukemia (T-ALL) improved survival outcomes. However, studies in low- and middle-income countries (LMICs) remain scarce. In this study, we evaluated survival rates and their associations with clinical factors within the context of the Brazilian Unified Health System.
Methods:
Data from 86 patients aged 0-19 years, diagnosed with T-ALL at one of four pediatric oncology reference centers of the Brazilian Unified Health System, were included in the study. Clinical, demographic, and laboratory variables were collected through a retrospective analysis of medical records.
Results:
Cohort survival rates revealed that the 5-year overall survival probability (pOS) and event-free survival probability (pEFS) for patients with T-ALL were 47% (37.3-59.3) and 43.2% (33.5-55.7), respectively, with infection being the main cause of death (69.4%). In both bivariate and multivariate analyses, the presence of adenomegaly at diagnosis was associated with lower pOS and pEFS. In addition, the GBTLI-HR protocol achieved the highest pOS (70.0%), compared to the 35.0% and 32.0% observed with the ALL IC-BFM 2002-HR and ALL IC-BFM 2009-HR protocols, respectively. This reinforces the need for context-specific adaptations of intensive treatment protocols in LMICs.
Conclusion:
This study offers valuable insights into the clinical and demographic characteristics of patients with T-ALL from Brazil, highlighting substantially higher mortality rates than those reported in HICs, primarily attributed to high infection rates.