{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T13:05:30Z","timestamp":1785416730334,"version":"3.56.0"},"reference-count":28,"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>Pediatric leukemia outcomes are poor in most low- and middle-income countries (LMICs) and exacerbated by health care systems ill equipped to manage cancer. Effective leukemia management in LMICs involves curating epidemiologic data; providing health care workforce specialty training; developing evidence-based treatments and supportive care programs; safeguarding access to medications and equipment; providing patient and family psychosocial, financial, and nutritional support; partnering with nongovernmental organizations, and ensuring treatment adherence.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>In 2013, through a partnership between North-American and Mexican institutions, we used the WHO Framework for Action, a health systems strengthening model to implement a leukemia care sustainable program aimed at improving acute lymphoblastic leukemia (ALL) outcomes at a public hospital in Mexico. We prospectively assessed clinical features, risk classification, and survival outcomes in children with ALL at Hospital General-Tijuana from 2008 to 2012 (preimplementation) and from 2013 to 2017 (postimplementation). We also evaluated program sustainability indicators.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Our approach led to a fully-staffed leukemia service, sustainable training programs, evidence-based and data-driven projects to improve clinical outcomes, and funding for medications, supplies, and personnel through local partnerships. Preimplementation and postimplementation 5-year overall survival for the entire cohort of children with ALL, children with standard-risk ALL, and children with high-risk ALL improved from 59% to 65% ( P = .023), 73% to 100% ( P &lt; .001), and 48% to 55% ( P = .031), respectively. All sustainability indicators improved between 2013 and 2017.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSION<\/jats:title><jats:p>Using the health systems strengthening WHO Framework for Action model, we improved leukemia care and survival in a public hospital in Mexico across the US-Mexico border. We provide a model for the development of similar programs in LMICs to sustainably improve leukemia and other cancer outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1200\/go.23.00123","type":"journal-article","created":{"date-parts":[[2023,6,3]],"date-time":"2023-06-03T12:00:21Z","timestamp":1685793621000},"update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":11,"title":["Childhood Leukemia Survival in the US-Mexico Border: Building Sustainable Leukemia Care Using Health Systems Strengthening Models"],"prefix":"10.1200","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0588-1532","authenticated-orcid":false,"given":"Paula","family":"Aristizabal","sequence":"first","affiliation":[{"name":"Peckham Center for Cancer and Blood Disorders, Rady Children's Hospital San Diego, San Diego, CA"},{"name":"Department of Pediatrics, Division of Pediatric Hematology\/Oncology, University of California San Diego, La Jolla, CA"},{"name":"Population Sciences, 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