Understanding adaptation and implementation challenges in pediatric ALL

In high-income countries (HICs), pediatric acute lymphoblastic leukemia (ALL) five-year survival rates are over 90%. However, survival remains much lower in low- and middle-income countries (LMICs), highlighting a major global outcome gap. Scalable, context-specific treatment guidelines are needed; however, differences in risk stratification, reporting and access to therapies make it difficult to implement HIC approaches in LMICs.

Work led by Caitlyn Duffy, MD, MPH, Departments of Oncology and Global Pediatric Medicine, analyzed 125 published pediatric ALL regimens to understand how and why protocols are adapted in different settings. Her work reveals that pediatric cancer treatment regimens in LMICs face both toxicity and implementation challenges, including limited drug availability, high costs and infrastructure constraints. The findings, which highlight the importance of implementation science for delivering practical treatment regimens across all resource settings, were published in JCO Global Oncology.

"This research shows that disparities in ALL outcomes are driven largely by implementation challenges,” said Duffy. “It highlights the importance of implementation science research and strategies such as the Global Platform for Access to Childhood Cancer Medicines to improve drug access and support adaptable, effective care worldwide."

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