Global socioeconomic disparities in ALL: treatment challenges

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 treatment challenges in ALL, including:

• Do treatment outcomes differ among race and ethnicity? Why do you think this is?

• What are the obstacles to treatment adherence?

• How do you sequence treatment in R/R B-ALL?

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 explained that regions with a lower human development index and fewer resources for the management of diagnosis and treatment in Argentina have lower survival outcomes. In Australia, many indigenous populations may have to travel long distances for treatment, which affects survival outcomes. Fleming suggests one way to overcome these barriers and drive better outcomes is to increase communication with patients, such as employing interpreters to educate patients about the importance of adhering to therapies.

Felice talked about limited access to stem cell transplantation as a key problem in Argentina, with protocols now aiming to reduce the number of patients undergoing this procedure. Similarly, Fleming discussed ongoing efforts to reduce the need for stem cell transplantation in patients with ALL.

Globally, inequities in access to CAR T-cell therapies are common. Fleming highlighted that patients with relapsed/refractory ALL aged <25 years have access to CAR T-cell therapies in Australia but those aged >25 years have no access outside of clinical trials. Conversely, Felice mentions no active CAR T-cell studies in Argentina.

Patients in Argentina have access to blinatumomab in the frontline setting, but no access to inotuzumab ozogamicin as yet; whereas, in Australia patients have access to both blinatumomab and inotuzumab ozogamicin.