Global socioeconomic disparities in ALL: diagnostic challenges in Brazil and Guatemala

This series of podcasts covers global socioeconomic disparity in ALL. In this episode, the ALL Hub asked Eduardo Chapchap, Hospital Israelita Albert Einstein, São Paulo, BR and Federico Antillion, Unidad Nacional de Oncologia Pediatrica, Guatemala City, GT 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?

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

Chapchap highlighted the lack of resources and genetic tests in Brazil, with some centers only having access to karyotyping and BCR::ABL testing. Also, the clonal heterogeneity of ALL presents challenges in diagnosis, and the literature is divided on the best molecular testing methods for assessing genetic alterations. Given that fewer cases of ALL are seen in adults, most of the genetic testing is restricted to research settings. The timing of results, which can sometimes take some months, also presents a challenge and possibly delays the timing of therapy.

Antillion echoed that there is limited access to molecular diagnostics in Guatemala, with testing only currently available for BCR::ABL, ETV::RUNX1, 4:11 and 1:11 translocations. Similarly, there is also no access to cytogenetics, though access to MRD testing has been recently available in a limited capacity. Overall, the limited access to resources and state of the art techniques as well as delays in receiving results can affect the management of patients with ALL.