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Determining the Significant Prognostic Factors for the Recurrence of Pediatric Acute Lymphoblastic Leukemia Using a
Anahita Saeedi1, Ahmadreza Baghestani2, Aliakbar Khadem Maboudi3
1Department of Biostatistics, School of Paramedical Sciences, Shahid Beheshti University, Tehran, Iran.
Insights
Identifying key factors for pediatric acute lymphoblastic leukemia (ALL) recurrence is crucial. Age over 10, central nervous system involvement, high white blood cell count, and tumor lysis syndrome significantly impact ALL outcomes.
Area of Science:
- Pediatric Oncology
- Hematology
- Cancer Epidemiology
Background:
- Acute lymphoblastic leukemia (ALL) is a leading cause of cancer death in children.
- Identifying prognostic factors is essential for improving pediatric ALL outcomes.
Purpose of the Study:
- To identify significant prognostic factors for the incidence of pediatric ALL recurrence and mortality.
- To evaluate the effectiveness of a three-parameter Gompertz model in predicting ALL outcomes.
Main Methods:
- Retrospective study of 417 pediatric ALL patients (2007-2016) in Mashhad, Iran.
- Diagnosis confirmed via Giemsa staining of bone marrow smears.
- Gompertz model used to analyze recurrence (event) and non-relapse mortality (competing event).
Main Results:
- Disease-free survival was 85.9%; 5-year overall survival was 74%.
- First ALL recurrence occurred in 10.6% of survivors.
- Significant prognostic factors for recurrence/mortality: age >10 years, CNS involvement, high WBC count, and tumor lysis syndrome.
Conclusions:
- The Gompertz model effectively identified prognostic factors for pediatric ALL.
- Age, CNS involvement, high WBC, and tumor lysis syndrome are critical factors influencing ALL recurrence and mortality.
- Close monitoring during treatment is recommended to mitigate risks.
Abstract:
Acute lymphoblastic leukemia (ALL) is the most common cause of cancer-related fatality among children. This study aimed to identify the significant prognostic factors for the incidence of pediatric ALL. This retrospective study, conducted from 2007 to 2016 in the Iranian city of Mashhad, enrolled 417 patients with ALL. The diagnosis was confirmed by Giemsa staining of bone marrow smears. The first recurrence was regarded as the event of interest and non-relapse mortality as the competing event through a three-parameter Gompertz model. The level of statistical significance for univariate and multivariate analyses was set at 0.2 and 0.05, respectively. The first recurrence occurred in 44 (10.6%) survivors. Disease-free survival and 5-year overall survival rates were 85.9% and 74%, correspondingly. The five-year incidence rate for the first recurrence was 11.5% in the presence of non-relapse mortality. Briefly, the characteristics of the Gompertz model conferred more effective prognostic factors. Age above 10 years (P=0.010), involvement of the central nervous system (P=0.050), a high white blood cell count (P=0.020), and tumor lysis syndrome (P=0.010) were the significant prognostic factors for the recurrence and mortality of ALL. Accordingly, careful monitoring in the administration of treatment protocols is suggested to reduce the risk of recurrence and death in these patients.
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