Children With Acute Lymphoblastic Leukemia in Romania: Results From a Decade-Long Single-Center Study

Area of Science:

• Pediatric Oncology
• Hematology
• Cancer Epidemiology

Background:

• Acute lymphoblastic leukemia (ALL) is the most common childhood cancer.
• Limited studies in Romania have analyzed ALL patient characteristics and survival outcomes.
• This study addresses this gap by examining 158 Romanian pediatric ALL patients.

Purpose of the Study:

• To profile pediatric ALL patients and disease characteristics in Romania.
• To analyze remission rates, relapses, and mortality.
• To assess survival outcomes, including the impact of minimal residual disease (MRD).

Main Methods:

• Retrospective analysis of 158 de novo ALL patients (0-17 years) from 2011-2021.
• Inclusion criteria: de novo ALL, <18 years, informed consent.
• Statistical analysis included descriptive statistics, Kaplan-Meier curves, and log-rank tests.

Main Results:

• Introduction of MRD testing in 2017 shifted patient stratification towards medium and high-risk groups.
• Patients with MRD >10% showed significantly better overall survival (OS) and event-free survival (EFS) compared to those with >25% blasts.
• Relapse rates were 11.4%, with specific outcomes for very early and late relapses.

Conclusions:

• The 2016-2020 cohort demonstrated higher OS than the 2011-2015 cohort, linked to MRD implementation.
• MRD testing significantly improved survival for patients with >10% residual disease.
• T-cell ALL and high leukocyte counts (>100,000/mm³) were associated with events occurring within the first year.