title: Real-world outcomes of treatment for acute lymphoblastic leukemia during adolescence in a financially restricted environment: Results at a single center in Latin America.
abstract: OBJECTIVE
  There is a paucity of the studies of adolescents with acute lymphoblastic leukemia (ALL). This is more noticeable in low- and middle-income countries. The international 5-year event-free survival (EFS) and overall survival (OS) for this age group is around 80%, with pediatric-inspired protocols offering better results.
  
  
  METHODS
  A retrospective analysis of adolescents aged 16-20 diagnosed with ALL during the period 2004-2015 treated with a high-risk pediatric protocol at an academic center from a middle-income country was performed. Five-year OS and EFS were estimated by the Kaplan-Meier analysis. Hazard ratios of relapse and death were estimated by the Cox regression model.
  
  
  RESULTS
  Five-year EFS and OS for 57 adolescents were 23.3% and 48.9%, respectively. From the 41 patients who achieved complete remission, 24 (58.5%) relapsed. Bone marrow and central nervous system were the most frequent sites of relapse. Hazard ratio of treatment failure and death for patients with organomegaly at diagnosis was 2.026 and 2.970, respectively. Treatment-related toxicity developed in 31 (54.4%) patients and febrile neutropenia was the most frequent in 14 (24.6%) cases. Twelve patients (21.1%) had poor adherence to treatment.
  
  
  CONCLUSIONS
  High relapse rate and low 5-year EFS compared with international standards, was documented. Use of intensified pediatric regimens, adherence to proven effective medications, improved supportive care, and prevention of abandonment are necessary to improve survival rates in these patients.
authors.affiliation: Internal Medicine Division, Department of Hematology, "Dr. José E. González" University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México.
authors.forename: José C
authors.initials: JC
authors.lastname: Jaime-Pérez
authors.affiliation: Internal Medicine Division, Department of Hematology, "Dr. José E. González" University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México.
authors.forename: Raúl A
authors.initials: RA
authors.lastname: Jiménez-Castillo
authors.affiliation: Internal Medicine Division, Department of Hematology, "Dr. José E. González" University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México.
authors.forename: Mónica A
authors.initials: MA
authors.lastname: Pinzón-Uresti
authors.affiliation: Internal Medicine Division, Department of Hematology, "Dr. José E. González" University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México.
authors.forename: Olga G
authors.initials: OG
authors.lastname: Cantú-Rodríguez
authors.affiliation: Internal Medicine Division, Department of Hematology, "Dr. José E. González" University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México.
authors.forename: José L
authors.initials: JL
authors.lastname: Herrera-Garza
authors.affiliation: Internal Medicine Division, Department of Hematology, "Dr. José E. González" University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México.
authors.forename: Luis J
authors.initials: LJ
authors.lastname: Marfil-Rivera
authors.affiliation: Internal Medicine Division, Department of Hematology, "Dr. José E. González" University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México.
authors.forename: David
authors.initials: D
authors.lastname: Gómez-Almaguer
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003906:Developing Countries; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007843:Latin America; D008137:Longitudinal Studies; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000401:mortality*; D016016:Proportional Hazards Models; D012074:Remission Induction; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: acute lymphoblastic leukemia; adherence; adolescence; compliance; survival rates