Outcomes of Pediatric Precursor B Cell Acute Lymphoblastic Leukemia: A Tertiary Care Cancer Center Experience from a Lower-Middle-Income Country
Abstract
Introduction
Precursor B-cell acute lymphoblastic leukemia (ALL) is the most common childhood malignancy. While cure rates in high-income countries (HICs) exceed 90%, outcomes in low- and middle-income countries (LMICs) remain suboptimal. This study evaluated treatment outcomes for pediatric pre-B cell ALL patients at a tertiary cancer hospital in an LMIC.
Materials and Methods
Pediatric precursor B-cell ALL patients treated at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Pakistan between September 2017 and September 2022 were included.
Results
A total of 436 pediatric patients were analyzed, with a median age of 3 years and a male predominance (61.5%). Most patients (96.3%) were classified as standard risk, while CNS and testicular involvement were rare. Among standard-risk patients, 81.8% achieved complete remission, and 17.4% remained minimal residual disease (MRD)-positive after induction. For high-risk patients, 75% achieved complete remission, and 25% remained MRD-positive at the end of induction. In total, 374 patients achieved remission, but 56 (14.9%) relapsed, most often as isolated bone marrow relapse (53.6%). Early relapse was most common. Overall mortality was 26.1%, with induction mortality at 11.7%. Sepsis was the leading cause of death (59.7%), followed by relapse (29%). Five-year overall survival (OS) and event-free survival (EFS) were 75.8% and 66.4%, respectively.
Conclusion
Our study demonstrates good outcomes for pediatric precursor B-cell ALL in a resource-limited LMIC setting. Sepsis and relapse were the main causes of mortality.
© 2026 Naeem Akram Butt, Najma Shaheen, Irfana Ishaq Sindhu, Amina Anwar, Saba Sattar, Hafiz Muhammad Mubashir Waheed, Hiba Asif, Ammarah Tahir, Aqeela Rashid, published by Shakuat Khanum Memorial Cancer Hospital and Research Centre
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