FEATURE
Blood Beyond Borders
Our newest series looks at blood disorders through a global lens, from international
trends in disease treatment to innovative initiatives in developing countries.
International Partnerships Lead to
Strides in Pediatric Leukemia in El Salvador
Although acute lymphocytic leukemia (ALL) is rela-
tively rare, it is the most common cancer diagnosed
in children, representing approximately one-quarter
of cancers diagnosed in those younger than 15
years. 1 Physicians and researchers made incredible
strides in treating ALL in children over the past few
decades, with the introduction of intrathecal chemo-
therapy combinations and refinement in dosing and
management of adverse events.
These developments transformed what was once
considered a uniformly fatal cancer into one with
a cure rate approaching 90 percent. However, these
advances didn’t translate to many low- and middle-
income countries, where the disease remained a
death sentence for children.
Until recently, El Salvador was one such country.
In 1990, more than 90 percent of children with ALL
did not survive into adulthood. That was the grim
prognosis facing the mother of a young Salvadoran
boy who was diagnosed with ALL in 1990, shortly
after his country had emerged from a civil war. The
mother, seeing no viable options for treatment in
El Salvador, decided to seek treatment in the U.S.,
recounted Raul C. Ribeiro, MD, a member of the
oncology department at St. Jude Children’s Research
Hospital in Memphis. She flew with her child to
Tennessee for treatment at St. Jude, but unfortu-
nately he died shortly thereafter.
Upon returning to El Salvador, the mother was
determined to bring medical expertise found in
ASHClinicalNews.org
the U.S. and other high-income countries back to
the children in her own country, so that they could
consistently receive efficient diagnoses and quality
treatment.
She founded the Fundación Ayúdame a Vivir
(Help Me to Live Foundation) in 1991 in memory of
her son. For two years, the foundation raised money
on its own. Then, in 1993, the mother delivered an
impassioned plea for help to representatives from St.
Jude; the hospital obliged.
Since 1997, Dr. Ribeiro has served as director of
the hospital’s International Outreach program – an
initiative to share knowledge, technology, and
organizational skills worldwide to help increase
childhood cancer cure rates. During his tenure, Dr.
Ribeiro has helped establish partnerships with 19
medical institutions in 14 countries.
These thriving collaborations have since become
models for treating cancer in other low- and middle-
income countries throughout the world: In 1993, the
five-year survival rate for children with ALL in El
Salvador was only 5 percent; in 2000, it climbed to
nearly 50 percent. 2
“With childhood leukemia, the single biggest
predictor of whether you recover or not is where
you happen to have been born,” Carlos Rodriguez-
Galindo, MD, chairman of St. Jude’s global pediatric
medicine department. told The New York Times. 3
“We’re talking about many thousands of young
children dying every single year of diseases that we
have known how to cure for decades.”
ASH Clinical News spoke with Dr. Ribeiro and
Roberto Vasquez, MD, a pediatric oncologist at
the Benjamin Bloom Hospital in El Salvador, about
the challenges of implementing this program, the
success it has generated, and where else such a
program might flourish.
Lower Income, Higher Prevalence
ALL is the most expensive childhood cancer to treat.
Recent estimates place the average cost of inpatient
treatment between $191,082 and $216,439, which
translated to daily costs ranging between $2,283 and
$2,840. 4
But it is estimated that 80 percent of children
who are diagnosed with cancer live in low- and
middle- income countries. 5 There, it is rare for a
child to have access to high-quality treatment, and
those who do are often forced to abandon it due to
high costs and long travel distances. Only one in five
of these children will be cured.
According to Dr. Vasquez, in 1991, the Benjamin
Bloom Hospital in San Salvador, El Salvador’s
tertiary care hospital for children, had no pediatric
oncologists or nurses on staff who were trained
specifically to care for patients with leukemia. At
the time, nearly half the country was in poverty
– meaning that few of the children who received
a timely diagnosis were able to pay for effective
treatment. Rates of treatment-related mortality
ASH Clinical News
45