Global socioeconomic disparities in ALL: toxicity

This series of podcasts covers 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 disparity in toxicities and their management in ALL, including:

• What are the toxicities you encountered while treating patients with ALL and how did you manage them?

• What are the barriers contributing to poor toxicity management?

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

Felice mentioned that diagnosis of non-frequent adverse events such as thrombosis, the management of infections given the differential access or incorrect use of antibiotics, and lack of nutritional care are some of the toxicity challenges faced in Argentina. A forum is underway for hematologists to discuss the best way to diagnose and treat complications of ALL.  

Fleming outlines that the management of toxicities in elderly patients is quite challenging, given higher rates of toxicity and lower tolerability; therefore, novel therapies are needed in Australia. Moreover, toxicities differ across populations, such as liver toxicities, pancreatitis, and thrombosis which are common in adults but rare in children; the literature and future protocols should recognize the key differences. Infections represent a major issue in HMICs, particularly among adult patients.