Global socioeconomic disparities in ALL: Diagnostic challenges

This series of podcasts covers the global socioeconomic disparity in ALL. In this episode, the ALL Hub asked Marisa Felice, Hospital of Pediatrics SAMIC, Buenos Aires, AR and Shaun Fleming, Alfred Hospital, Melbourne, AU about the diagnostic challenges in ALL, including:

• What are the barriers to understanding the genetics of ALL? 

• Is there a lack of MRD, cytogenetic and molecular testing in the real-world setting?

• Does this affect your approaches to managing patients?

Felice and Fleming discussed socioeconomic disparities in ALL across high middle-income countries (HMIC), low middle-income countries (LMIC), and within adult and pediatric populations.

Felice shared that the extensive diagnostic landscape in Argentina, including 25 centers focused on performing flow cytometry and flow minimal residual disease (MRD) assessments, and another 15 centers with a focus on genetic analyses presents a challenge. She highlighted the lack of human resources and training, particularly in genetic analyses, the logistical challenges in the shipping of samples, the disparities in access to diagnostic tests across the centers, and the persuasion of others about the relevance of different diagnostic testing.

Fleming echoed that convincing others about the value of specific diagnostic tests has been difficult across adult centers in Australia and has followed a sequential process over the years, first with genetic testing and more recently with the acceptance of MRD testing across all centers; although variation in diagnostic procedure exists. Overall, larger centers have widely accepted and adopted these diagnostic techniques though smaller and regional centers, with fewer cases of ALL, are gradually getting to a wider stage of acceptance. Public funding for diagnostic testing is often more difficult to acquire than funding for therapeutics and this impacts diagnosis overall.

Felice and Fleming both commented on how access to diagnostic procedures affects the management of patients locally. Felice highlighted that convincing private hospitals on accreditation of MRD testing is a difficult process compared with public hospitals due to there being fewer cases of ALL, economic issues, and lack of quality of control which affects the survival rates of patients. Smaller centers with fewer cases and/or specific regions with less access to medications and lower management of complications and toxicities in both LMICs and HMICs also affects survival rates.