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Childhood Acute Lymphoblastic Leukemia (ALL): Four Years Evaluation of Protocols 2013 and 2016 in a Single Center in Indonesia, a Low-Middle Income Country
  • +13
  • Sutaryo Sutaryo,
  • Pudjo Widjajanto,
  • Sri Mulatsih,
  • Bambang Ardianto,
  • Alexandra Pangarso,
  • Eddy Supriyadi,
  • Ignatius Purwanto,
  • Claudia Adelin,
  • Rahmadani Lestari,
  • Lintang Sagoro,
  • Scolastika Kristian,
  • Dea Sabrina,
  • Natasha Verena,
  • Arjenne Kors,
  • Gertjan Kaspers,
  • Anjo JP Veerman
Sutaryo Sutaryo
Universitas Gadjah Mada
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Pudjo Widjajanto
Dr. Sardjito Hospital
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Sri Mulatsih
Rumah Sakit Umum Pusat Dr Sardjito
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Bambang Ardianto
Rumah Sakit Umum Pusat Dr Sardjito
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Alexandra Pangarso
Rumah Sakit Umum Pusat Dr Sardjito
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Eddy Supriyadi
Pediatric Hematology Oncology Division
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Ignatius Purwanto
Rumah Sakit Umum Pusat Dr Sardjito
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Claudia Adelin
Rumah Sakit Umum Pusat Dr Sardjito
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Rahmadani Lestari
Universitas Gadjah Mada
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Lintang Sagoro
Rumah Sakit Umum Pusat Dr Sardjito
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Scolastika Kristian
Rumah Sakit Umum Pusat Dr Sardjito
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Dea Sabrina
Rumah Sakit Umum Pusat Dr Sardjito
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Natasha Verena
Rumah Sakit Umum Pusat Dr Sardjito
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Arjenne Kors
Princess Maxima Center for Pediatric Oncology
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Gertjan Kaspers
Princess Maxima Center for Pediatric Oncology
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Anjo JP Veerman
VU Amsterdam
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Abstract

Background: As in LMICs, the prognosis of childhood ALL in Indonesia was lower than in HICs. Indonesian-ALL2013 protocol resulted in more toxicities and abandonments than expected. Therefore, it was modified into a pilot ALL2016 protocol. Changes to the ALL2013 protocol: no anthracyclines in SR, dexamethasone replaced prednisone in reinduction for HR and some drugs were rescheduled. Procedure: We compare the outcome of ALL2013 and ALL2016. Results: A total of 383 children with ALL were diagnosed, 21 were excluded. ALL2013 included 174 patients (106 SR and 68 HR) and ALL2016 188 (91 SR and 97 HR). The outcome of the ALL2016 was better than the ALL2013 (pOS 67.0% vs 60.3%; p=0.087 and pEFS 50.0% vs 37.9%; p=0.012) even when the number of HR patients was significantly higher in ALL2016 (51.6% vs 39.1%). The ALL2016 showed an early advantage for SR patients (pEFS 56.7% vs 47.2%; p=0.114 and pOS 74.4% vs 69.8%; p=0.298) due to the decrease of toxic deaths (10.4% vs 5.5%; p=0.211) however the number of late relapses were still high (19.5% vs 13.2%; p=0.282). In the HR group, both pEFS and pOS were significantly better in ALL2016 (pEFS 43.3% vs 23.5%; p=0.010 and pOS 59.8% vs 45.6%; p=0.036) due to less relapses (14.4% vs 29.4%; p=0.019). Both SR and HR showed a smaller number of abandonments in ALL2016. Conclusions: After small changes in protocol, initial toxicity and abandonments were reduced and the pOS and pEFS were improved. However, relapses still need to be lessened in the next protocol.
07 Jul 2021Submission Checks Completed
07 Jul 2021Assigned to Editor
07 Jul 2021Submitted to Pediatric Blood & Cancer
19 Nov 2021Reviewer(s) Assigned
07 Dec 2021Review(s) Completed, Editorial Evaluation Pending
08 Dec 2021Editorial Decision: Revise Major
05 Mar 2022Assigned to Editor
05 Mar 2022Submission Checks Completed
05 Mar 20221st Revision Received
17 Mar 2022Reviewer(s) Assigned
30 Mar 2022Review(s) Completed, Editorial Evaluation Pending
11 Apr 2022Editorial Decision: Revise Minor
18 May 2022Submission Checks Completed
18 May 2022Assigned to Editor
18 May 20222nd Revision Received
22 May 2022Reviewer(s) Assigned
04 Jun 2022Review(s) Completed, Editorial Evaluation Pending
09 Jun 2022Editorial Decision: Accept