{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T16:25:23Z","timestamp":1793118323508,"version":"4.5.0"},"reference-count":23,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"9","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO Global Oncology"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:sec><jats:title>PURPOSE<\/jats:title><jats:p>Acute lymphoblastic leukemia (ALL) represents around 70% of pediatric leukemia. In high-income countries, the 5-year survival is above 90%, but survival in low- and middle-income countries is inferior. This study documents the treatment outcome and prognostic factors of pediatric ALL in Pakistan.<\/jats:p><\/jats:sec><jats:sec><jats:title>MATERIALS AND METHODS<\/jats:title><jats:p>In this prospective cohort study, all newly diagnosed patients with ALL\/lymphoblastic lymphoma from age 1 to 16 years enrolled between January 1, 2012, and December 31, 2021, were included. The treatment was based on the standard arm of the UKALL2011 protocol.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Data from 945 patients with ALL, including 597 males (63.2%), were analyzed. The mean age at diagnosis was 5.73 \u00b1 3.51 years. Pallor was the commonest presentation in 95.2% followed by fever in 84.2% of patients. The mean WBC count was 56.6 \u00b1 103.4 \u00d7 10<jats:sup>9<\/jats:sup>\/L. Neutropenic fever followed by myopathy was the most common complication during induction. In univariate analysis, the high WBC count ( P \u2264 0.001), intensive chemotherapy ( P \u2264 0.001), malnutrition ( P = .007), poor response to induction chemotherapy ( P = .001), delayed presentation ( P = .004), and use of steroids before chemotherapy ( P = .023) significantly adversely affected overall survival (OS). The delayed presentation was the most significant prognostic factor in the multivariate analysis ( P \u2264 .002). After a median follow-up of 54.64 \u00b1 33.80 months, the 5-year OS and disease-free survival (DFS) were 69.9% and 67.8%, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSION<\/jats:title><jats:p>In this largest cohort of childhood ALL from Pakistan, a high WBC count, malnutrition, delayed presentation, previous steroids use, intensive chemotherapy, and poor response to the induction chemotherapy were associated with decreased OS and DFS rates.<\/jats:p><\/jats:sec>","DOI":"10.1200\/go.22.00288","type":"journal-article","created":{"date-parts":[[2023,6,8]],"date-time":"2023-06-08T19:59:36Z","timestamp":1686254376000},"update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":29,"title":["Pediatric Acute Lymphoblastic Leukemia: Clinical Characteristics, Treatment Outcomes, and Prognostic Factors: 10 Years' Experience From a Low- and Middle-Income 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