title: Secular trends and predictors of mortality in acute lymphoblastic leukemia for children of low socioeconomic level in Northeast Brazil.
abstract: BACKGROUND
  The treatment for ALL has evolved in recent decades and as a result survival rates are now close to 90% in many developed countries. However, this is not the case in developing countries where survival rates are often below 35%. More than 80% of children who are affected by ALL worldwide live in developing countries. The objective of this study was to evaluate the secular trend in mortality for children with ALL living in Sergipe, a state in northeastern Brazil, and to investigate any association with variables that relate to socioeconomic status.
  
  
  METHODS
  This study evaluated ALL patients who were less than 20 years of age and who were treated at the Dr. Osvaldo Leite Oncology Center in the capital city, Aracaju. The sample comprised two cohorts of patients from the public health service: patients treated from 1980 to 2004 (cohort A) and from 2005 to 2014 (cohort B). The findings were compared to those of patients treated in the one private service for pediatric cancer treatment available in the region, from 2005 to 2014 (cohort C). Two categories of variables were considered in this study: biological and socioeconomic.
  
  
  RESULTS
  We analyzed 412 patients who were divided into three cohorts (cohort A: 287 patients, cohort B: 106 patients and cohort C: 19 patients). The mortality rates for the three cohorts were significantly different: 57.5% in cohort A, 45.3% in cohort B and 26.3% in cohort C (p=0.006). Mortality during induction in cohort B was 22.6%, while in cohort C no deaths occurred during this phase (p=0.041). Patients living in rural areas had higher mortality rates (p=0.036).
  
  
  CONCLUSIONS
  The reduction in deaths from infection during induction seems to be the starting point for improving the chances for children and adolescents with ALL anywhere in the world.
authors: Federal University of Sergipe, Brazil. Electronic address: simonesvi@yahoo.com.br.
authors: Simone Santana
authors: SS
authors: Viana
authors: Federal University of Sergipe, Brazil. Electronic address: ylla.lmmrl@gmail.com.
authors: Leyla Manoella Maurício Rodrigues
authors: LM
authors: de Lima
authors: Federal University of Sergipe, Brazil. Electronic address: julianabriton@hotmail.com.
authors: Juliana Brito
authors: JB
authors: do Nascimento
authors: Federal University of Sergipe, Brazil. Electronic address: cafcardoso@live.com.
authors: Carlos André Ferreira
authors: CA
authors: Cardoso
authors: Federal University of Sergipe, Brazil. Electronic address: caroldantasr@hotmail.com.
authors: Ana Carolina Dantas
authors: AC
authors: Rosário
authors: Federal University of Sergipe, Brazil. Electronic address: cristiano@iocm.com.br.
authors: Cristiano de Queiroz
authors: Cde Q
authors: Mendonça
authors: Federal University of Sergipe, Brazil. Electronic address: oamneto28@gmail.com.
authors: Osvaldo Alves
authors: OA
authors: de Menezes-Neto
authors: Federal University of Sergipe, Brazil. Electronic address: rosanaci@yahoo.com.
authors: Rosana
authors: R
authors: Cipolotti
mesh_terms: D000293:Adolescent; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality*; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Acute lymphoblastic leukemia; Children; Infection; Low socioeconomic level; Mortality