Improved outcomes in pediatric acute lymphoblastic leukemia (ALL) with adapted treatment intensity: the use of SIOP-PODC ALL

regimen 2 in a resource-limited tertiary referral setting

Caneba, J. P., Estanislao, J., Fajardo, P., Lam, C., and Alcasabas, A. P.

December 8, 2022

Summary

The Philippine General Hospital (PGH) is a government tertiary referral institution that sees 350 new cancer patients each year,
including children with acute lymphoblastic leukemia. The hospital implemented the International Society of Pediatric Oncology in
Poor Countries graduated intensity ALL regimen in 2009, but there were high rates of toxic death and failure to start/complete therapy
at baseline, which were key causes of mortality. The PODC ALL regimen, which included delayed intensification and radiation for
high-risk patients, was effectively implemented in 2012, and the first known prospective cohort of patients managed on it was reported
in a low- and middle-income country. In addition, the hospital has established programs for leukemia patient navigation, blood drives,
free drug access, and data management, as well as a pediatric cancer unit. Service delivery and infrastructure are being developed to
further enhance the effectiveness of the treatment.

Nursing Implications

A. To Nursing Profession

Improving knowledge on treatment of leukemia can improve rates of pediatric survival. Nursing personnel took proactive steps
to strengthen their knowledge of acute lymphoblastic leukemia, which improved the patient's comprehension. This study also
found that the observation group's knowledge mastery rate and scores were significantly higher than those in the control group,
corroborating prior findings that individualized health education approaches might increase patients' understanding of relevant
knowledge.

B. To Nursing Education

The research show that personalized health education nursing can increase the coverage of care knowledge, so it can improve
the efficiency of nursing work and the clinical treatment of patients. This study will improve nurses’ ability to work with the
families of the patient to be able to bear better results for the patient.

C. To Nursing Research

Cancer treatment is difficult to get in many low-income countries, and LIC pediatric oncology initiatives have resulted in
significant improvements in outcomes for children with ALL. Over the last few decades, a proposal for a systematic and graduated
approach to ALL diagnosis, risk classification, and treatment in LICs has been developed, beginning with a first-level regimen
similar to CCG therapy in the early 1980s and then layering on successive treatment intensifications proven effective in randomized
clinical trials. This proposal establishes a structure for LIC centers to deliver effective ALL treatment, especially in areas where
few children are currently treated.

Personal Insights

The study proved that the universal use of the SIOP PODC ALL adaptive intensity regimen 2 is possible in a tertiary referral environment
and has been linked to improved OS and fewer toxic fatalities. To address the major cause of treatment failure, more measures such as
improved risk assessment, treatment intensification, salvage therapy, better CNS control methods, and pediatric oncology nurse training
are required.