CELL INTELLIGENCE · 肿瘤细胞治疗研究

Acute lymphoblastic leukemia (ALL) incidence in Mexico and Central America is among the highest worldwide, with a significant proportion of cases occurring in adolescents and young adults (AYA). Historically, outcomes for Mexican adults with ALL have been poor, driven by high treatment-related mortality, limited access to specialized care and diagnostics, and a higher prevalence of adverse-risk genetic subtypes, including Philadelphia-like ALL.

During the last decade, pediatric-inspired regimens (PIR) have transformed the management of AYA ALL globally, but their implementation in low- and middle-income countries poses unique challenges.

We describe the adaptation and stepwise implementation of a modified CALGB 10403 (mCALGB) regimen in Mexico, replacing pegaspargase with native E. coli asparaginase and standardizing supportive care. Across six centers in Mexico and Guatemala, 95 patients treated with mCALGB achieved a complete remission rate of 87. 8%, 2-year overall survival (OS) of 72. 1%, and relapse rate of 28. 3%, markedly improved compared with historical Mexican cohorts and approaching outcomes of the original CALGB 10403 trial. Similar results have been reproduced by other Latin American groups using BFM- or CALGB-based regimens.

Key challenges remain, including higher rates of induction infections, metabolic toxicities linked to obesity and Hispanic ancestry, and major disparities in access to diagnostics and novel agents such as blinatumomab and CAR-T cells. Future priorities include national strategies to expand precision diagnostics, collaborative clinical research, and equitable implementation of innovative therapies. Pediatric-inspired regimens adapted to local resources represent a critical step toward closing the survival gap for Hispanic AYA patients with ALL.