title: Childhood acute lymphoblastic leukemia in Nicaragua: long-term results in the context of an international cooperative program.
abstract: BACKGROUND
  The aim of this paper is to describe the results of acute lymphoblastic leukemia (ALL) treatment in Nicaragua from 1995 to 2005 in the context of an international cooperation program.
  
  
  METHODS
  Patients <18 years with ALL were treated with two consecutive protocols (1995 and 2000). After a steroid prophase, a three-drug induction was administered in protocol 1995, and a four-drug induction, including asparaginase, was administered in protocol 2000. In protocol 2000, a modified BFM phase IB with cyclophosphamide, 6-mercaptopurine and cytosine arabinoside was administered to patients at high risk (HR), who also received IV methotrexate (500 mg/m(2)) in the consolidation phase. Reinduction consisted of dexamethasone, vincristine, doxorubicin, cytosine arabinoside, and 6-thioguanine administered over 7 (protocol 1995) or 4 (protocol 2000) weeks; reinduction was repeated twice for patients at HR. Maintenance consisted of p.o. 6-mercaptopurine and methotrexate, and vincristine and dexamethasone pulses were added in the 2000 study. The total duration of therapy was 24 months.
  
  
  RESULTS
  In total, 540 patients were treated. Overall, 7% of patients died during induction, and 9% abandoned treatment. At 5 and 10 years from diagnosis, event-free survival (EFS) rates of 38.1% and 36.6%, respectively, and overall survival rates of 48.0% and 39.6%, respectively, were obtained, considering abandonment as an event.
  
  
  CONCLUSIONS
  In our experience, a 10-year EFS of 36.6% was achieved in a country with limited resources. Factors limiting a higher success rate were treatment abandonment and a high relapse rate.
authors.affiliation: Department of Pediatric Oncology, Manuel de Jesus Rivera Hospital, Managua, Nicaragua.
authors.forename: Carlos
authors.initials: C
authors.lastname: Pacheco
authors.forename: Giovanna
authors.initials: G
authors.lastname: Lucchini
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Valsecchi
authors.forename: Alberto
authors.initials: A
authors.lastname: Malta
authors.forename: Valentino
authors.initials: V
authors.lastname: Conter
authors.forename: Andronica
authors.initials: A
authors.lastname: Flores
authors.forename: Andrea
authors.initials: A
authors.lastname: Biondi
authors.forename: Gianni
authors.initials: G
authors.lastname: Tognoni
authors.forename: Mercedes
authors.initials: M
authors.lastname: Arguello
authors.forename: Franco
authors.initials: F
authors.lastname: Cavalli
authors.forename: Daniela
authors.initials: D
authors.lastname: Silvestri
authors.forename: Fulgencio Baez
authors.initials: FB
authors.lastname: Lacayo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Masera
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007391:International Cooperation; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000401:mortality; D009527:Nicaragua; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000401:mortality; D011379:Prognosis; D015996:Survival Rate; D013997:Time Factors
keywords: childhood acute lymphoblastic leukemia; cooperation programs; long-term results; low-income countries; twinning program