title: Outcome of childhood acute lymphoblastic leukaemia in resource-poor countries.
abstract: The causes of treatment failure in childhood acute lymphoblastic leukaemia are thought to differ between resource-rich and resource-poor countries. We assessed the records of 168 patients treated for this disease in Honduras. Abandonment of treatment (n=38), the main cause of failure, was associated with prolonged travel time to the treatment facility (2-5 h: hazard ratio 3.1, 95% CI 1.2-8.1 vs >5 h: 3.7, 1.3-10.9) and age younger than 4.5 years (2.6, 1.1-6.3). 35 patients died of treatment-related effects. Outcome could be substantially improved by interventions that help to prevent abandonment of therapy (such as funding for transport, satellite clinics, and support groups), and by prompt treatment of infection.
authors.affiliation: Department of Hematology-Oncology and International Outreach Program, St Jude Children's Research Hospital, Memphis, TN 38105-2794, USA. monika.metzger@stjude.org
authors.forename: Monika L
authors.initials: ML
authors.lastname: Metzger
authors.forename: Scott C
authors.initials: SC
authors.lastname: Howard
authors.forename: Ligia C
authors.initials: LC
authors.lastname: Fu
authors.forename: Armando
authors.initials: A
authors.lastname: Peña
authors.forename: Rene
authors.initials: R
authors.lastname: Stefan
authors.forename: Michael L
authors.initials: ML
authors.lastname: Hancock
authors.forename: Zhe
authors.initials: Z
authors.lastname: Zhang
authors.forename: Ching Hon
authors.initials: CH
authors.lastname: Pui
authors.forename: Judy
authors.initials: J
authors.lastname: Wilimas
authors.forename: Raul C
authors.initials: RC
authors.lastname: Ribeiro
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000592:standards / Q000706:statistics & numerical data; D006721:Honduras; D006801:Humans; D007223:Infant; D008297:Male; D008507:Medically Underserved Area; D010352:Patient Dropouts / Q000706:statistics & numerical data; D011203:Poverty / Q000706:statistics & numerical data; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D012307:Risk Factors; D017211:Treatment Failure