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Childhood acute nonlymphocytic leukemia in 88 patients
Insights
Treatment outcomes for childhood acute nonlymphocytic leukemia (ANLL) were poor, with low remission and survival rates. Patient compliance significantly impacted remission duration and survival, highlighting the need for better supportive care and socioeconomic considerations.
Area of Science:
- Pediatric Oncology
- Hematology
- Clinical Research
Background:
- Acute nonlymphocytic leukemia (ANLL) in children presents significant treatment challenges.
- Treatment protocols from 1978-1991 varied, with limited routine cerebrospinal fluid examination.
- Supportive care measures included antibiotics for febrile neutropenia and blood components for cytopenias.
Purpose of the Study:
- To retrospectively analyze treatment outcomes in 88 newly diagnosed children with ANLL.
- To evaluate the impact of patient compliance on remission duration and survival.
- To identify factors influencing treatment success in pediatric ANLL.
Main Methods:
- Retrospective analysis of 88 pediatric ANLL patients diagnosed between 1978 and 1991.
- Chemotherapy administered according to standard protocols of the era.
- Assessment of patient compliance and its correlation with outcomes.
Main Results:
- Overall complete remission rate was 50.9% (n=57), with a median remission duration of 5 months and median survival of 11 months.
- Compliant patients (n=31) showed similar complete remission rates (51.6%) but longer median remission (14 months) and survival (6 months).
- Early death occurred in 21.1% of all patients, with higher rates in compliant and acute promyelocytic leukemia subgroups.
Conclusions:
- Treatment outcomes for childhood ANLL during this period were suboptimal, influenced by chemotherapy, supportive care, and socioeconomic factors.
- Patient compliance emerged as a critical factor affecting remission duration and survival.
- Improved supportive care and addressing socioeconomic determinants are crucial for enhancing pediatric ANLL treatment outcomes.
Abstract:
In this study, 88 newly diagnosed children with acute nonlymphocytic leukemia (ANLL) were retrospectively analyzed for their treatment outcome. The patients included 51 boys and 37 girls, aged from four months to 14 years 11 months (median, seven years one month). The treatment consisted of chemotherapy using protocols which were standard at the time of diagnosis (1978-1991). Cerebrospinal fluid was not routinely examined. Fever with neutropenia was treated with empiric combination antibiotics, and anemia and thrombocytopenia were treated with blood components. Non-compliance was frequent; it was estimated that only 35.6% of all patients followed the given instructions. For the overall group (n = 57), 50.9% achieved confirmed complete remission. Median remission duration was five months and survival time was 11 months. The probability of continuous remission at 24 months was 20.9%. For the compliant group (n = 31), 51.6% attained complete remission, with a median remission duration of 14 months. The probability of continuous remission at 24 months was 44.5%, and the median survival time was six months. Early death occurred in 21.1% of all patients, 38.7% of compliant patients and 85.7% of acute promyelocytic leukemia patients. This study demonstrates how supportive treatment, socioeconomic factors and chemotherapy interact and affect the treatment outcome of ANLL in children.