低收入和中等收入国家的儿科ALL治疗修改:系统性审查
Caitlyn Duffy1, Savannah Allen2, Thomas B Alexander3,4
1Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN.
JCO global oncology
|December 15, 2025
概括
由于实施障碍,低收入和中等收入国家的儿科急性淋巴细胞白血病 (ALL) 治疗方案经常被调整. 修改后的治疗方案显示了更高的生存率,强调了需要更好的结果报告.
科学领域:
- 儿科瘤学 儿科瘤学
- 全球健康 全球健康
- 实施科学 实施科学
背景情况:
- 在低收入和中等收入国家 (LMICs) 的儿童急性淋巴细胞白血病 (ALL) 的治疗方案通常需要调整.
- 这些适应方案的临床影响和常见修改在全球范围内尚不清楚.
研究的目的:
- 检查LMICs中使用的儿科ALL治疗方案.
- 识别影响全球ALL护理的适应模式和障碍.
- 描述与适应疗法相关的结果范围.
主要方法:
- 在七个数据库中,按照PRISMA指南进行了系统审查.
- 分析了2000-2021年在LMICs中所有方案的数据,重点是地理分布,骨干采用,修改和结果.
- 使用描述性统计数据来总结文章的特点.
主要成果:
- 包括125篇文章,详细介绍36个国家的163种饮食方案;84.6%使用高收入饮食作为支柱.
- 64%的疗法得到了调整,最常见的变化是减少/放弃高剂量甲状腺.
- 实施挑战 (药物获取,成本) 是更常见的修改原因,而不是毒性,但实施结果很少被衡量 (6.4%).
- 修改后与未修改后的治疗方案中,五年整体存活率明显高于未修改后的治疗方案 (P = .030).
结论:
- 实施障碍是全球ALL疗法调整的主要驱动因素.
- 关于适应方案的实施结果报告的文献中存在很大的差距.
- 整合实施科学对于在各种资源环境中有效提供创新的ALL治疗方法至关重要.
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