• Pediatric ALL patients

• Pediatric B-cell precursor / T-cell ALL patients

• Standard / high / very-high-risk ALL groups

• Long-term ALL survivors (373 in follow-up)

• National new pediatric ALL cases (20-25/yr at MMH)

• Domestic/intl pediatric oncology trainees

MacKay Children's Hospital Pediatric Hematology/Oncology, led by Director Ting-Chi Yeh, has organized Taiwan's pediatric ALL treatment since 1993 when Dr. Der-Cheng Liang (succeeded by Dr. Hsi-Che Liu in 2017) drafted TPOG ALL 1993, TPOG ALL 1997 VHR, TPOG ALL 2002, and TPOG ALL 2013 (the new generation planned for 2020-2021). MacKay pediatric ALL 1999-2010 cure rate 90.6% (published J Clin Oncol 2014, IF 28.245)—surpassing Japan JCCLS 89.2% and Singapore Ma-Spore 89.2%, ranking #1 in Asia. The division sees ~60 new pediatric cancer cases/year (50% acute leukemia); 27 new ALL cases in 2018 was Taiwan's highest; 373 long-term survivors under follow-up. Cross-disciplinary team spans pediatric mental health, surgery, neurology, neurosurgery, nursing, critical care, genetics, orthopedics, GI, dermatology, nutrition, pharmacy, pathology, radiology, radiation oncology, ENT, rehab, nephrology, ophthalmology, cardiology, endocrinology, infectious disease, oral-maxillofacial surgery, social services, bedside education teachers, and pastoral care. Five features: (1) innovative CNS leukemia treatment improving cure rate; (2) innovative CNS leukemia prevention; (3) innovative supportive care reducing severe bacterial/fungal infection (NHI reimbursement 2017); (4) Asia-#1 pediatric ALL cure rate; (5) Asia-#1 research publications.

• Asia-#1 cure rate (90.6%)

• Led 4 generations of TPOG ALL plans

• Innovative CNS leukemia treatment (replaces cranial RT)

• World-innovative delayed intrathecal chemotherapy

• Antibiotic/antifungal prophylaxis covered by NHI

• 20+ specialty cross-disciplinary care

• 60 new pediatric cancer cases/yr at MMH

• 20-25 ALL new diagnoses/yr

• 27 cases in 2018 (national #1)

• 373 long-term survivors in follow-up

• Referrals from 13 counties

• Led 4 generations of TPOG ALL plans

• Cure rate 90.6% (Asia #1)

• Higher than Japan JCCLS 89.2%

• Higher than Singapore Ma-Spore 89.2%

• Taiwan 1997-2007 cure rate 77.1%

• Significantly reduced severe infection

• Cranial late effects avoided

• CNS prevention avoids cranial RT late effects

• Delayed intrathecal reduces bleeding

• Prophylactic antibiotics reduce severe infection

• Team Resource Management cross-team care

• TPOG multicenter quality control

• Case manager resource coordination

• Patients receive TRM cross-team care

• Bedside teachers provide schooling guidance

• Pastoral spiritual counseling

• Medical specialists accompany invasive procedures to reduce anxiety

• High family endorsement

• Trust earned across 13 counties

• 1999-2010 outcomes in J Clin Oncol 2014 IF 28.245

• 2010 Leukemia IF 9.944 publication

• CNS treatment in Pediatr Blood Cancer IF 2.486

• Multiple Cancer IF 6.102 publications

• J Clin Oncol 2015 IF 28.245 intl comparison

• Asia-#1 in research publication count

• Leads Taiwan pediatric ALL treatment quality

• Influences Asian pediatric ALL guidelines

• NHI reimbursement for prophylactic antibiotics/antifungals

• Trained TPOG pediatric hematologists at multiple hospitals

• International cure rate benchmark

• Cooperation with academia and pediatric society