Year: 2013
Type: editorial
Abstract: Treatment of pediatric acute lymphoblastic leukemia (ALL) is one of the major successes in cancer medicine.Fifty years ago, this disease was incurable.Today, a child diagnosed with ALL in highincome countries in North America, Western Europe, Australia, New Zealand or Japan has a better than 90% chance of surviving 5 years, with expected cure rates above 85%. 1-3However, most children who develop ALL do not live in one of these countries, all of which have highly developed health care systems; they live in countries with fewer resources.A major challenge is thus to improve cure rates for children with ALL throughout the world.Although difficult, this challenge is feasible because the gains in childhood ALL survival in high-income countries have occurred mostly through optimizing use of an existing panel of drugs.Except for the pegylated asparaginase products now used in treatment regimens of the major North American and European cooperative groups, these drugs are readily available worldwide and not particularly expensive. 4In addition, effective ALL treatment can be provided with relatively simple diagnostic tests and does not involve surgery.Because of this, many but certainly not all countries have access to the tools necessary to deliver highly effective ALL therapy.However, ALL chemotherapy regimens are complex, require meticulous supportive care to minimize the risk of treatment-related mortality, and typically last 2 to 3 years.Thus, highly trained medical specialists and a dedicated team of nurses and other health care professionals are needed to implement effective ALL treatment programs.6][7][8][9] In the article that accompanies this editorial, Stary et al 10 describe results of more than 5,000 children with ALL enrolled onto the International BFM Intercontinental trial (ALL IC-BFM) between 2002 and 2007.Fifteen countries participated in the ALL IC-BFM 2002 trial, contributing from 36 to 1,270 patients, each.Using World Bank definitions almost all of the 15 are classified as high-income countries, on the basis of gross national income (GNI) per capita of more than $12,616 US, although several countries (Cuba, Serbia, Ukraine) are classified as upper middle-income countries (GNI per capita $4,086-$12,615).However, the GNI per capita for most of these countries is less than $20,000 as compared with $35,000 to $50,000 (or more) for the United States, Canada, Japan, Australia, and most countries in Western Eu-
Source: Journal of Clinical Oncology
Author: Stephen P. Hunger
Institutions: Children's Hospital Colorado, University of Colorado Anschutz
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2145602938