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Updated: Oct 9, 2026
Modeling Chemotherapy Resistant Leukemia In Vitro
Published on: February 9, 2016
Low socioeconomic status is a strong independent predictor of relapse in childhood acute lymphoblastic leukemia
M B Viana1, R A Fernandes, R I de Carvalho
1Department of Pediatrics, Federal University of Minas Gerais, Belo Horizonte, Brazil. vianamb@medicina.ufmg.br
Insights
Childhood acute lymphoblastic leukemia (ALL) outcomes are significantly impacted by socioeconomic status (SES) and height-for-age z-score (HAZ). Poor SES and low HAZ predict a higher risk of relapse in pediatric ALL patients.
Area of Science:
- Pediatric Oncology
- Hematology
- Social Determinants of Health
Background:
- Treatment outcomes for childhood acute lymphoblastic leukemia (ALL) are influenced by biological factors, treatment regimens, and individual variability.
- Socioeconomic and cultural disparities significantly affect pediatric ALL prognosis, particularly in developing nations, and are often misattributed to ethnic differences.
Purpose of the Study:
- To investigate the impact of malnutrition and socioeconomic status (SES) on the outcome of pediatric ALL in Brazil.
- To adjust for known biological factors and elucidate the prognostic influence of social determinants.
Main Methods:
- Prospective study of 167 children with ALL treated with a Berlin-Frankfurt-Munster-based protocol.
- Assessment of socioeconomic indicators (housing, income, energy consumption) and nutritional status (height-for-age z-score [HAZ], weight-for-age z-score).
- Univariate and Cox's multivariate regression analyses to identify predictive factors for relapse and disease-free survival.
Main Results:
- Estimated disease-free survival was 43% at a median follow-up of 1623 days, with bone-marrow relapse being the primary cause of remission failure.
- Univariate analysis showed significant association between indicators of poverty (poor housing, low income, low energy consumption) and increased relapse risk.
- Multivariate analysis, after adjusting for biological factors, identified poor socioeconomic status (SES) and low height-for-age z-score (HAZ) as independent predictors of relapse.
Conclusions:
- Poor socioeconomic status (SES) and malnutrition (low HAZ) are significant independent predictors of relapse in children with acute lymphoblastic leukemia (ALL).
- The findings highlight social inequality as a critical factor influencing pediatric ALL prognosis.
- Addressing social determinants of health is crucial for improving outcomes in pediatric ALL treatment.
Abstract:
The results of the treatment of acute lymphoblastic leukemia (ALL) in children depend not only on the biologic diversity of the leukemia cell, the multi-drug treatment schedule and the individual variability of drug metabolism, but also on the socioeconomic and cultural background of the leukemic child. Social and cultural disparity is very marked in underdeveloped countries and has been increasing in industrialized nations. The prognostic influences of these factors are poorly documented and sometimes mistakenly attributed to differences in ethnic origin. We have investigated in Brazil the relative impact of malnutrition and socioeconomic status on the outcome of ALL, adjusting for the known influence of biologic factors. Children with ALL (n = 167) treated with a Berlin-Frankfurt-Munster-based protocol were studied prospectively. At a median follow-up of 1623 days, the estimated probability of disease-free survival was 43 +/- 4%. The main cause for interruption of remission was bone-marrow relapse. Socioeconomic indicators of poverty (poor housing conditions, low per capita income and energy consumption) were significantly associated with a greater risk of relapse in univariate analysis. They were consolidated in a single index, socioeconomic status (SES), defined by the product of monthly per capita income times mean familial daily energy consumption. Other unfavorable findings included age, z score for the height for age at diagnosis (HAZ) below-1.28 and the z score for weight for age below-1.28. After adjustment in Cox's multivariate model, only HAZ and poor SES remained as predictive factors for relapse. Poor prognosis for leukemic children of low SES is just another indicator of social inequality.
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