Treatment outcome in pediatric patients with T-ALL in Brazil.

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.