{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T18:14:03Z","timestamp":1760292843569,"version":"build-2065373602"},"reference-count":15,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2012,11,16]],"date-time":"2012-11-16T00:00:00Z","timestamp":1353024000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2013,3,15]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>BACKGROUND:<\/jats:title><jats:p>Outcomes for relapsed childhood acute lymphoblastic leukemia (ALL) have not been documented in resource\u2010limited settings. This study examined survival after relapse for children with ALL in Central America.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS:<\/jats:title><jats:p>A retrospective cohort study was performed and included children with first relapse of ALL in Guatemala, Honduras, or El Salvador between 1990 and 2011. Predictors of subsequent event\u2010free survival (EFS) and overall survival (OS) were examined.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS:<\/jats:title><jats:p>There were 755 children identified with relapsed disease. The median time from diagnosis to relapse was 1.7 years (interquartile range, 0.8\u20103.1 years). Most relapses occurred during (53.9%) or following (24.9%) maintenance chemotherapy, and the majority occurred in the bone marrow (63.1%). Following the initial relapse, subsequent 3\u2010year EFS (\u00b1 standard error) and OS were 22.0% \u00b1 1.7%, and 28.2% \u00b1 1.9%, respectively. In multivariable analysis, worse postrelapse survival was associated with age \u2265 10 years, white blood cell count \u2265 50 \u00d7 10<jats:sup>9<\/jats:sup>\/L, and positive central nervous system status at the original ALL diagnosis, relapse that was not isolated central nervous system or testicular, and relapse &lt; 36 months following diagnosis. Site and time to relapse were used to identify a favorable risk group whose 3\u2010year EFS and OS were 50.0% \u00b1 8.9% and 68.0% \u00b1 8.1%, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS:<\/jats:title><jats:p>Prognosis after relapsed ALL in Central America is poor, but a substantial number of those with favorable risk features have prolonged survival, despite lack of access to stem cell transplantation. Stratification by risk factors can guide therapeutic decision\u2010making. Cancer 2013. \u00a9 2012 American Cancer Society.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.27846","type":"journal-article","created":{"date-parts":[[2012,11,17]],"date-time":"2012-11-17T08:20:57Z","timestamp":1353140457000},"page":"1277-1283","source":"Crossref","is-referenced-by-count":11,"title":["Outcome of children treated for relapsed acute lymphoblastic leukemia in Central America"],"prefix":"10.1002","volume":"119","author":[{"given":"Stacey","family":"Marjerrison","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Federico","family":"Antillon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ligia","family":"Fu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roxana","family":"Martinez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberto","family":"Vasquez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miguel","family":"Bonilla","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott C.","family":"Howard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lillian","family":"Sung","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2012,11,16]]},"reference":[{"key":"e_1_2_6_2_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2010.30.7405"},{"key":"e_1_2_6_3_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2010-07-294678"},{"key":"e_1_2_6_4_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2009.22.2950"},{"key":"e_1_2_6_5_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2007.10.7508"},{"key":"e_1_2_6_6_2","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.21941"},{"key":"e_1_2_6_7_2","doi-asserted-by":"publisher","DOI":"10.1038\/leu.2008.251"},{"key":"e_1_2_6_8_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2009.25.1983"},{"key":"e_1_2_6_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2010.09.020"},{"key":"e_1_2_6_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2010.07.001"},{"key":"e_1_2_6_11_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2004-04-1616"},{"key":"e_1_2_6_12_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0900386"},{"key":"e_1_2_6_13_2","doi-asserted-by":"publisher","DOI":"10.1038\/leu.2008.22"},{"key":"e_1_2_6_14_2","first-page":"227","article-title":"POND4Kids: a web\u2010based pediatric cancer database for hospital\u2010based cancer registration and clinical collaboration","volume":"164","author":"Quintana Y","year":"2011","journal-title":"Stud Health Technol Inform."},{"key":"e_1_2_6_15_2","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.20966"},{"key":"e_1_2_6_16_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.26107"}],"container-title":["Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fcncr.27846","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cncr.27846","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T17:32:21Z","timestamp":1760290341000},"score":1,"resource":{"primary":{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/10.1002\/cncr.27846"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2012,11,16]]},"references-count":15,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2013,3,15]]}},"alternative-id":["10.1002\/cncr.27846"],"URL":"https:\/\/doi.org\/10.1002\/cncr.27846","archive":["Portico"],"relation":{},"ISSN":["0008-543X","1097-0142"],"issn-type":[{"type":"print","value":"0008-543X"},{"type":"electronic","value":"1097-0142"}],"subject":[],"published":{"date-parts":[[2012,11,16]]}}}