Are there regional variations in the presentation of childhood leukemia?

Introduction: Treatment of childhood acute lymphoblastic leukemia (ALL) is basedon risk stratification. This study aimed to assess the agreement between risk groupclassifications in the different childhood ALL treatment protocols used in a referralhospital in southern Brazil.Methods: We retrospectively reviewed the medical records of patients aged 1 to18 years with B-cell ALL treated at a hospital from January 2013 to April 2017. Agreementbetween risk classifications was assessed by the kappa coefficient.Results: Seventy-five patients were analyzed. There was poor agreement betweenrisk stratification by GBTLI 2009 and BFM 95 protocols (kappa=0.22; p = 0.003) andby GBTLI 2009 and IC-BFM 2002 protocols (kappa=0.24; p = 0.002). Risk groupdistribution was 13.3% for low risk, 32.0% for intermediate risk, and 54.7% for highrisk based on stratification by the GBTLI 2009 protocol, and 28.0% for low risk, 42.7%for intermediate risk, and 29.3% for high risk based on stratification by the IC-BFM2002 protocol. Overall survival was 68.6%.Conclusion: This study provides numerous points to ponder about the treatmentof leukemia in Brazil. The percentage of patients classified as high risk in oursample was higher than that reported in the international literature. This difference,however, had no impact on overall survival, which was shorter than that reportedin the international literature