Clinical outcomes in pediatric acute lymphoblastic leukemia using modified BFM-95 protocol: 10-year study in Mexico City.
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BACKGROUND: Although survival rates for acute lymphoblastic leukemia (ALL) in developed countries have reached up to 80%, outcomes remain considerably lower in emerging nations. This study aimed to evaluate the 10-year survival of pediatric patients with ALL treated at a public hospital using the HP 09 protocol, adapted from the BFM 95 protocol. METHODS: We included patients under 17 years of age diagnosed with ALL and treated with the HP 09 protocol between January 2010 and December 2020. Patients were stratified into 3 risk groups according to clinicobiological characteristics. RESULTS: A total of 253 patients were analyzed. The cohort demonstrated a 10-year overall survival (OS) rate of 58.1% (90.4 ± 4.8 months) and an event-free survival (EFS) rate of 56.9% (78.2 ± 5.0 months). By risk group, the 10-year OS was 41% in the high-risk group, 61.9% in the intermediate-risk group, and 85.7% in the standard-risk group. Corresponding 10-year EFS rates were 55.2%, 57.1%, and 59.7%. Cox regression analysis identified older age (>10 years; OR = 2.11, 95% CI = 1.36 to 3, P = .001), leukocyte count >50 × 109/L (OR = 1.89, 95% CI = 1.22 to 2.93, P = .004), and prior steroid exposure before diagnosis (OR = 2.30, 95% CI = 1.16 to 4.58, P = .017) as significant predictors of relapse. CONCLUSIONS: This study highlights a substantial disparity in survival rates among pediatric patients with ALL in Mexico compared with international benchmarks. The gap likely reflects differences in chemotherapy efficacy, disease biology, and systemic healthcare limitations.