Outcome of pediatric acute myeloid leukemia (AML) in low- and middle-income countries: a systematic review of the literature

<b>Introduction</b>: Survival rates of pediatric acute myeloid leukemia (AML) in low- and middle-income countries (LMICs) seem extremely poor, and the available literature on the matter is scarce. Accordingly, there is a limited understanding of poor treatment outcomes seen in this population. <b>Areas covered</b>: We provide an overview of the available literature with respect to treatment outcomes of pediatric AML in LMICs yielding poor outcomes compared to high-income countries. Moreover, treatment outcomes vary markedly between LMICs. In addition, there is a wide variation among studies in how treatment outcomes are reported and analyzed. <b>Expert opinion</b>: The substantially inferior treatment outcomes of pediatric AML in LMICs emphasize the unprecedented importance of global initiatives and international collaborations to improve the survival of these patients. A coordinated approach is necessary to carry out country-specific situational analyses. These analyses will result in operational plans on how to structurally implement childhood cancer registries, align healthcare infrastructure, build on capacities, and provide universal health coverage in LMICs. In addition, we strongly recommend that, in the future, LMICs document, analyze, and publish pediatric AML treatment outcomes in a more structured and uniform manner.

**引言**：低收入和中等收入国家（low- and middle-income countries, LMICs）的儿童急性髓系白血病（pediatric acute myeloid leukemia, AML）患者生存率极低，且相关现有研究文献较为匮乏，因此学界对该群体治疗结局不佳的成因仍缺乏充分认知。

**综述范围**：本文系统梳理了现有关于低收入和中等收入国家儿童AML治疗结局的相关文献——相较于高收入国家，该类国家的儿童AML治疗结局普遍欠佳；同时，不同低收入和中等收入国家间的治疗结局亦存在显著差异。此外，现有研究在治疗结局的报告与分析范式上也存在较大分歧。

**专家观点**：低收入和中等收入国家儿童AML的治疗结局显著劣于其他地区，这凸显了开展全球行动与国际协作以改善该类患者生存状况的空前重要性。需采取协同推进的方式开展国别国情分析，基于此类分析可制定实操方案，用于在低收入和中等收入国家系统性搭建儿童癌症登记系统、优化医疗基础设施、提升医疗服务能力并实现全民健康覆盖。此外，我们强烈建议未来低收入和中等收入国家应以更结构化、统一的标准，对儿童AML的治疗结局进行记录、分析与发布。