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Published on: September 18, 2013
Pediatric Acute Lymphoblastic Leukemia: Clinical Characteristics, Treatment Outcomes, and Prognostic Factors: 10
Ishfaq Ahmad1, Tariq Ghafoor1,2, Anwar Ullah1
1Department of Paediatric Oncology, Combined Military Hospital, Rawalpindi, Pakistan.
Insights
Pediatric acute lymphoblastic leukemia (ALL) survival is lower in Pakistan. Key factors reducing survival include high white blood cell counts, malnutrition, and delayed presentation for treatment.
Area of Science:
- Pediatric Oncology
- Hematology
- Clinical Research
Background:
- Acute lymphoblastic leukemia (ALL) is the most common childhood cancer, accounting for approximately 70% of pediatric leukemias.
- While survival rates exceed 90% in high-income nations, outcomes remain suboptimal in low- and middle-income countries.
- Understanding treatment outcomes and prognostic factors in diverse settings is crucial for improving pediatric cancer care.
Purpose of the Study:
- To document the treatment outcomes for pediatric patients diagnosed with acute lymphoblastic leukemia (ALL) in Pakistan.
- To identify significant prognostic factors influencing survival in this specific population.
- To provide data from a large cohort to inform future treatment strategies.
Main Methods:
- A prospective cohort study was conducted, enrolling newly diagnosed pediatric patients (ages 1-16) with ALL or lymphoblastic lymphoma.
- Patient data were collected from January 1, 2012, to December 31, 2021.
- Treatment followed the standard arm of the UKALL2011 protocol.
Main Results:
- The study analyzed data from 945 pediatric ALL patients, with a mean age of 5.73 years.
- Common presenting symptoms included pallor (95.2%) and fever (84.2%).
- Significant adverse prognostic factors identified were high white blood cell (WBC) count, intensive chemotherapy, malnutrition, poor response to induction chemotherapy, delayed presentation, and prior steroid use. Delayed presentation was the most significant factor in multivariate analysis. The 5-year overall survival (OS) and disease-free survival (DFS) were 69.9% and 67.8%, respectively.
Conclusions:
- High WBC count, malnutrition, delayed presentation, prior steroid use, intensive chemotherapy, and poor induction chemotherapy response are associated with reduced survival in pediatric ALL patients in Pakistan.
- Delayed presentation emerged as the most critical negative prognostic factor.
- These findings highlight the need for early diagnosis and management to improve outcomes for childhood ALL in resource-limited settings.
Purpose:
Acute lymphoblastic leukemia (ALL) represents around 70% of pediatric leukemia. In high-income countries, the 5-year survival is above 90%, but survival in low- and middle-income countries is inferior. This study documents the treatment outcome and prognostic factors of pediatric ALL in Pakistan.
Materials And Methods:
In this prospective cohort study, all newly diagnosed patients with ALL/lymphoblastic lymphoma from age 1 to 16 years enrolled between January 1, 2012, and December 31, 2021, were included. The treatment was based on the standard arm of the UKALL2011 protocol.
Results:
Data from 945 patients with ALL, including 597 males (63.2%), were analyzed. The mean age at diagnosis was 5.73 ± 3.51 years. Pallor was the commonest presentation in 95.2% followed by fever in 84.2% of patients. The mean WBC count was 56.6 ± 103.4 × 109/L. Neutropenic fever followed by myopathy was the most common complication during induction. In univariate analysis, the high WBC count (P ≤ 0.001), intensive chemotherapy (P ≤ 0.001), malnutrition (P = .007), poor response to induction chemotherapy (P = .001), delayed presentation (P = .004), and use of steroids before chemotherapy (P = .023) significantly adversely affected overall survival (OS). The delayed presentation was the most significant prognostic factor in the multivariate analysis (P ≤ .002). After a median follow-up of 54.64 ± 33.80 months, the 5-year OS and disease-free survival (DFS) were 69.9% and 67.8%, respectively.
Conclusion:
In this largest cohort of childhood ALL from Pakistan, a high WBC count, malnutrition, delayed presentation, previous steroids use, intensive chemotherapy, and poor response to the induction chemotherapy were associated with decreased OS and DFS rates.
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