title: Improving treatment of children with acute lymphoblastic leukemia in developing countries through technology sharing, collaboration and partnerships.
abstract: Cure rates for pediatric acute lymphoblastic leukemia differ markedly in higher- and lower-income countries due to disparate hospital infrastructure and resources. Where means are limited, treatment-related mortality is higher and compliance may be suboptimal. Upfront risk assignment is aimed at individualizing therapy according to presenting features in order to avoid over- or under-treatment. However, the necessary technical resources and expertise are not always readily available. The authors provide suggestions for management of childhood acute lymphoblastic leukemia in developing nations. To improve patient care locally, the authors recommend that communication technology be used to sustain partnerships between sponsoring and partner pediatric oncology programs. The aims of these collaborations should be to prioritize resources, identify existing problems and reduce treatment intensity and hence treatment-related morbidity and mortality in patients at lower risk of relapse.
authors.affiliation: International Outreach Program and Department of Oncology, St Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA.
authors.forename: Gaston K
authors.initials: GK
authors.lastname: Rivera
authors.forename: Raul C
authors.initials: RC
authors.lastname: Ribeiro
mesh_terms: D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D002648:Child; D003906:Developing Countries; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use; D018365:Neoplasm, Residual / Q000473:pathology; D010317:Partnership Practice; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*
chemical_list: D000964:Antimetabolites, Antineoplastic; D008727:Methotrexate
keywords: acute lymphoblastic leukemia; lower- and higher-income countries; minimal residual disease; partner institution; reduced intensity chemotherapy; risk-directed therapy; sponsor institution