ArticleJournal of global oncology2018
Outcomes of Low-Intensity Treatment of Acute Lymphoblastic Leukemia at Butaro Cancer Center of Excellence in Rwanda.
Registry-linked trialAbstract read
In one paragraph
Article in Journal of global oncology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06928909 (Evaluating the Feasibility of an Intensity-Adapted Pediatric Acute Myeloid Leukemia Treatment Guideline in Malawi), which is not on this map. Cited by 9 papers, 1 of them a synthesis that pooled it.
0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 1 pooled it
–field-weighted citation impact
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Evaluating the Feasibility of an Intensity-Adapted Pediatric Acute Myeloid Leukemia Treatment Guideline in Malawi
Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Acute and Chronic Leukemia in Sub-Saharan Africa: A Systematic Review.Cancer reports (Hoboken, N.J.) · 2026Pooled it
- Childhood cancer survival in low- and middle-income countries and the Global South: emerging evidence and critical gaps from a scoping review of observational studies.EJC paediatric oncology · 2025Review
- Article
- One-Year Survival and Prognosticators of Adults With Acute Leukemia at the Uganda Cancer Institute.JCO global oncology · 2023Article
- Article
- Clinical Characteristics and Outcomes of Acute Lymphoblastic Leukemia in Adolescents and Young Adults in Malawi.JCO global oncology · 2022Observational
- Acute Leukemia Classification Using Transcriptional Profiles From Low-Cost Nanopore mRNA Sequencing.JCO precision oncology · 2022Article
- Experience and Perception of Patients and Healthcare Professionals on Acute Leukemia in Rwanda: A Qualitative Study.Cancer management and research · 2022Article
- Implementation of a graduated-intensity approach for acute lymphoblastic leukemia in a Rwandan district hospital.Blood advances · 2018Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
16 authors.
Fidel RubagumyaFidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT.
Mary Jue XuFidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT.
Leana MayFidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT.
Caitlin DriscollFidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT.
Frank Regis UwizeyeFidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT.
Cyprien ShyirambereFidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT.
Katherine LarrabeeFidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT.
Alexandra E FehrFidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT.
Umuhizi Denis GilbertFidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT.
Clemence MuhayimanaFidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT.
Vedaste HategekimanaFidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT.
Shekinah ElmoreFidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT.
Tharcisse MpungaFidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT.
Molly MooreFidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT.
Lawrence N ShulmanFidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT.
Leslie LehmannFidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeChildren with acute lymphoblastic leukemia (ALL) in low-income countries have disproportionately lower cure rates than those in high-income countries. At Butaro Cancer Center of Excellence (BCCOE), physicians treated patients with ALL with the first arm of the Hunger Protocol, a graduated-intensity method tailored for resource-limited settings. This article provides the first published outcomes, to our knowledge, of patients with ALL treated with this protocol.
methodsThis is a retrospective descriptive study of patients with ALL enrolled at BCCOE from July 1, 2012 to June 30, 2014; data were collected through December 31, 2015. Descriptive statistics were used to calculate patient demographics, disease characteristics, and outcomes; event-free survival was assessed at 2 years using the Kaplan-Meier method.
resultsForty-two consecutive patients with ALL were included. At the end of the study period, 19% (eight) were alive without evidence of relapse: three completed treatment and five were continuing treatment. Among the remaining patients, 71% (30) had died and 10% (four) were lost to follow-up. A total of 83% (25) of the deaths were disease related, 3% (one) treatment-related, and 13% (four) unclear. Event-free survival was 22% (95% CI, 11% to 36%), considering lost to follow-up as an event, and 26% (95% CI, 13% to 41%) if lost to follow-up is censored.
conclusionAs expected, relapse was the major cause of failure with this low-intensity regimen. However, toxicity was acceptably low, and BCCOE has decided to advance to intensity level 2. These results reflect the necessity of a data-driven approach and a continual improvement process to care for complex patients in resource-constrained settings.
Indexed as
Antineoplastic Combined Chemotherapy ProtocolsAsparaginaseCancer Care FacilitiesChildCyclophosphamideDeveloping CountriesDexamethasoneFemaleHumansMaleMercaptopurineMethotrexateNeoplasm Recurrence, LocalPrecursor Cell Lymphoblastic Leukemia-LymphomaPrednisoneRecurrenceAsparaginaseCyclophosphamideDexamethasoneMercaptopurineMethotrexatePrednisoneVincristine
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LicenceCC BY
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Registered trials
NCT06928909ClinicalTrials.gov
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.