{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T08:09:27Z","timestamp":1789805367248,"version":"4.0.1"},"reference-count":21,"publisher":"Walter de Gruyter GmbH","issue":"1","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/3.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Precursor B-cell acute lymphoblastic leukemia (ALL) is the most common childhood malignancy. While cure rates in high-income countries (HICs) exceed 90%, outcomes in low- and middle-income countries (LMICs) remain suboptimal. This study evaluated treatment outcomes for pediatric pre-B cell ALL patients at a tertiary cancer hospital in an LMIC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>Pediatric precursor B-cell ALL patients treated at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Pakistan between September 2017 and September 2022 were included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 436 pediatric patients were analyzed, with a median age of 3 years and a male predominance (61.5%). Most patients (96.3%) were classified as standard risk, while CNS and testicular involvement were rare. Among standard-risk patients, 81.8% achieved complete remission, and 17.4% remained minimal residual disease (MRD)-positive after induction. For high-risk patients, 75% achieved complete remission, and 25% remained MRD-positive at the end of induction. In total, 374 patients achieved remission, but 56 (14.9%) relapsed, most often as isolated bone marrow relapse (53.6%). Early relapse was most common. Overall mortality was 26.1%, with induction mortality at 11.7%. Sepsis was the leading cause of death (59.7%), followed by relapse (29%). Five-year overall survival (OS) and event-free survival (EFS) were 75.8% and 66.4%, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our study demonstrates good outcomes for pediatric precursor B-cell ALL in a resource-limited LMIC setting. Sepsis and relapse were the main causes of mortality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2478\/jcas-2026-0017","type":"journal-article","created":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T07:25:38Z","timestamp":1789802738000},"page":"129-135","source":"Crossref","is-referenced-by-count":0,"title":["Outcomes of Pediatric Precursor B Cell Acute Lymphoblastic Leukemia: A Tertiary Care Cancer Center Experience from a Lower-Middle-Income Country"],"prefix":"10.2478","volume":"12","author":[{"given":"Naeem Akram","family":"Butt","sequence":"first","affiliation":[{"name":"Pediatric Oncology Department , Shaukat Khanum Cancer Hospital & Research Center , Lahore . Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Najma","family":"Shaheen","sequence":"additional","affiliation":[{"name":"Pediatric Oncology Department , Shaukat Khanum Cancer Hospital & Research Center , Lahore . Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irfana Ishaq","family":"Sindhu","sequence":"additional","affiliation":[{"name":"Pediatric Oncology Department , Shaukat Khanum Cancer Hospital & Research Center , Lahore . Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amina","family":"Anwar","sequence":"additional","affiliation":[{"name":"Pediatric Oncology Department , Shaukat Khanum Cancer Hospital & Research Center , Lahore . Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saba","family":"Sattar","sequence":"additional","affiliation":[{"name":"Pediatric Oncology Department , Shaukat Khanum Cancer Hospital & Research Center , Lahore . Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hafiz Muhammad Mubashir","family":"Waheed","sequence":"additional","affiliation":[{"name":"Pediatric Oncology Department , Shaukat Khanum Cancer Hospital & Research Center , Lahore . 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ALL induction outcome: real-world data from a pediatric oncology centre in an LMIC setup with rural predominance. Indian J Cancer. 2024;61(2):215\u2013223. doi:10.4103\/ijc.ijc_355_21.","DOI":"10.4103\/ijc.ijc_355_21"},{"key":"2026091907253134044_j_jcas-2026-0017_ref_002","doi-asserted-by":"crossref","unstructured":"Gupta S, Hunger SP. Recent trends in the results of studies conducted by the Children\u2019s Oncology Group acute lymphoblastic leukemia committee and implications for emerging cooperative trial groups in low- and middle-income countries. Pediatr Hematol Oncol J. 2020;5(4):151\u2013155. doi:10.1016\/j.phoj.2020.03.001.","DOI":"10.1016\/j.phoj.2020.03.001"},{"key":"2026091907253134044_j_jcas-2026-0017_ref_003","doi-asserted-by":"crossref","unstructured":"Arora RS, Arora B. Acute leukemia in children: a review of the current Indian data. South Asian J Cancer. 2016;5(3):155\u2013160. doi:10.4103\/2278-330X.187591.","DOI":"10.4103\/2278-330X.187591"},{"key":"2026091907253134044_j_jcas-2026-0017_ref_004","doi-asserted-by":"crossref","unstructured":"Thakkar D, Upasana K, Udayakumar DS, Rastogi N, Chadha R, Arora S, et al. Treatment of pediatric acute lymphoblastic leukemia in India as per modified BFM-95 protocol with minimal residual disease monitoring. Hematology. 2025;30(1). doi:10.1080\/16078454.2024.2439733.","DOI":"10.1080\/16078454.2024.2439733"},{"key":"2026091907253134044_j_jcas-2026-0017_ref_005","unstructured":"Alejandro G, Lewis BS. Acute lymphoblastic leukemia. In: Orkin SH, Fisher DE, Ginsburg D, Look AT, Lux SE, Nathan DG, editors. Nathan and Oski\u2019s Hematology and Oncology of Infancy and Childhood. 8th ed. Philadelphia: Elsevier; 2015. p. 1527\u20131554."},{"key":"2026091907253134044_j_jcas-2026-0017_ref_006","unstructured":"Children\u2019s Cancer Trials Team. UKALL 2011 protocol. Version 3.0. 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