INTRODUCTION
Acute lymphoblastic leukemia (ALL) is the most common malignant disease
diagnosed in children, with a prevalence of up to 26 % of all childhood
malignant diseases in patients under the age of 15 1.
While the survival rate in 1960 was only a few percent, outcome was
improved successively with the development of combination chemotherapy
in successive cooperative clinical trials, resulting in long term
survival in over 90% of children today 2. This
progress is based on treatment optimization trials with risk-adapted
treatment, on leukemia biology and response to treatment. Furthermore,
supportive care was improved, in particular prevention and treatment of
severe infections. Additionally, treatment was intensified such as
including consolidation with stem cell transplantations (SCT)3. However, 70 % of children in the world live in low
income countries, where the development of effective leukemia therapy
remains very challenging, given the limitations in infrastructure,
resources, trained personnel and thus access to care, with outcomes that
are often still lower than 35% 4. Furthermore, it is
also estimated that less than 60% of children worldwide even have
access to cancer treatment 5. There is a lot of data
available about childhood ALL in Europe and in the USA, but comparable
data from most Asian countries, especially from low and lower-middle
income countries like Cambodia, is still scarce even though it is
estimated that there are 54 000 new ALL cases per year in Asia6. The health care system in Cambodia has only limited
resources (Yeoh et al., 2014) and gaining access to a hospital is often
difficult financially and geographically. For 30 years the Kantha Bopha
Foundation has provided free health care in 5 hospitals in two locations
to an estimated 85 % of all Cambodian children. Based on the
development of available expertise, including laboratories for
infectiology and hematology with the possibility to perform whole blood
transfusions and a dedicated staff, ALL therapy was introduced based on
a treatment protocol with a moderate reduction of treatment intensity
for all patients 7 in one central location in Phnom
Penh. Here, we analyze the results of this treatment regimen over a
period of three years with sufficient follow-up time as a basis for
further development for pediatric oncology care.