Treatment outcomes of children with acute lymphoblastic leukemia in a middle-income developing country: high mortalities, early relapses, and poor survival

Abdelmabood, Suzy; Fouda, Ashraf; Boujettif, Fatimah; Mansour, Ahmed

doi:10.1016/j.jped.2018.07.013

Cited by 45 publications

(69 citation statements)

References 26 publications

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“…ALL is the commonest childhood malignancy and the 5‐year event‐free survival (EFS) is now approaching 90% in developed countries . However, the survival outcome is still suboptimal in developing countries . A recent multicenter study from China reported 5‐year EFS of 79.9% .…”

Section: Discussionmentioning

confidence: 99%

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Septicemia after chemotherapy for childhood acute lymphoblastic leukemia in China: A multicenter study CCCG‐ALL‐2015

et al. 2020

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Background Septicemia is an important cause of treatment‐related mortality and treatment failure in pediatric acute lymphoblastic leukemia (ALL) in developing countries. A multicenter CCCG‐ALL‐2015 study was conducted in China and factors associated with septicemia and mortality were studied. Methods Patients participated in CCCG‐ALL‐2015 study from January 2015 to December 2017 were included. Patients with documented septicemia were identified from the Data Center and additional data were collected. Results A total of 4080 patients were recruited in the study and 527 patients with septicemia were identified (12.9%, 95% CI 11.9%‐13.9%). The intermediate risk (IR)/high risk (HR) group had significantly higher incidence of septicemia as compared with low risk (LR) group, 17.1% vs 9.1% (OR 2.07, 95% CI 1.71‐2.49, P < .001). Induction phase was the period with majority of septicemia episodes happened, 66.8% in LR and 56.1% in IR/HR groups. Gram‐positive bacteria accounted for 54.1%, gram‐negative bacteria 44.5%, and fungus 1.4% of positive cultures. Multidrug‐resistant organisms were detected in 20.5% of all organisms. The mortality rate after septicemia was 3.4% (95% CI 1.9%‐4.9%). Multiple logistic regression identified female gender, comorbid complications, and fungal infection as risk factors associated with mortality. Gram‐negative septicemia was associated with higher mortality, 4.9% vs 1.4% (OR 0.28, 95% CI 0.09‐0.88, P = .02). There was marked variation in the incidence of septicemia among the 18 centers, from 4.8% to 29.1%. Conclusion Overall the incidence and pattern of septicemia in this multicenter study in China was similar to the reports of western countries. The septicemia‐related mortality rate was low. There was marked variation in the incidence of septicemia among the centers.

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Section: Discussionmentioning

confidence: 99%

“…[5][6][7] However, the survival outcome is still suboptimal in developing countries. 8,9 A recent multicenter study from China reported 5-year EFS of 79.9%. 10 most important cause of treatment failure.…”

Section: Discussionmentioning

confidence: 99%

Septicemia after chemotherapy for childhood acute lymphoblastic leukemia in China: A multicenter study CCCG‐ALL‐2015

et al. 2020

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“…The much higher L2 and high risk prevalence comparing to other studies may reflect an underlying cause, such as from war or environment as many practices in Syria may contain leukemogenesis such as unprotected pesticide usage, mate drinking and hookah smoking, mainly in low educational level population 24 . It is suggested that the protocols that were developed in the advanced centres might increase the rate of death as these protocols are not adjusted to the local conditions of low-and mid-income countries 2,3 , and therefore more studies are required in developing countries such as Syria for adjustment of protocols that change ALL variables. Although the cost of treatment in Syria is covered, there is data suggesting that families within low SES are correlated with worse prognosis in children as determination of indirect costs is difficult 8 which can explain having lower educational parents was correlated with poorer prognosis in our study.…”

Section: Symptoms Fbc and Organomegaly Most Patients Presented Withmentioning

confidence: 99%

“…Although ALL is curable, many parts of the world may not have access to modern treatment. Approximately eight to nine of every ten children that have ALL are considered long-term survivors and cured in developed countries, but these reults markedly differ in developping countries 2,3 . These positive outcomes are due to having access to top treatments at the most advanced institutions 2 .…”

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confidence: 99%

Rates and trends of childhood acute lymphoblastic leukaemia: an epidemiology study

Kakaje

Alhalabi

Ghareeb

et al. 2020

Sci Rep

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Acute lymphoblastic leukaemia (ALL) is the most common childhood cancer and has a high survival rate when properly managed. prognosis is correlated with many factors such as age, gender, white blood cell (WBC) count, CD10, French-American-British (FAB) classification, and many others. Many of these factors are included in this study as they play a major role in establishing the best treatment protocol. this study aims to demonstrate clinical and laboratory features of childhood ALL in Syria. they were treated at children's University Hospital, the only working major cancer centre in Syria at the time of the study. Data of 203 patients who aged 0-14 years were obtained for this study. Most patients (48.8%) aged (5-9) years with a male predominance (60.9%). The major features for ALL included lymphadenopathy (82.9%), presenting with systemic symptoms (74.9%), TALL subclass (20.2%), L2 FAB classification (36.1%), low educational levels for fathers (53%) and mothers (56.2%), having a high risk (48.4%), and having a duration of symptoms before evaluation for more than 4 weeks (42.6%). Only three (1.5%) patients had normal full blood counts (FBC) and only one (0.5%) patient had an isolated high WBC count at time of presentation. Most patients had either abnormal platelet count (89.3%) or low haemoglobin level (88.8%) when presenting with only (2.0%) having normal levels for both. This suggests that having normal haemoglobin and platelet count can be used for quick screening in crisis time like in Syria for prioritising patients. Many prognostic factors were significantly different from medical literature which emphasises the importance of local studies in the developping countries. this study included a high prevalence of Tall , L2 FAB classification, high-risk and other variables which require further studies to evaluate the aetiology of these features, especially that treatment protocols may have a higher mortality in developing countries when not adjusted to local variables.

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“…In recent years, with the gradual improvement of chemotherapy regimens and the progress of individualized treatment, the complete remission rate and long-term disease-free survival rate of childhood acute leukemia has been signi cantly improved (1) . Infection is part of the most important factors causing the death and treatment failure of childhood leukemia therapy (2)(3)(4). Studies have shown that neutrophil de ciency after intensive chemotherapy in leukemia is closely linked to infection-related complications (5).…”

Section: Introductionmentioning

confidence: 99%

Characteristics of Gut Microbiome and Prediction of Infection in Neutropenic Children with Acute Leukemia

Wang

et al. 2020

Preprint

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Background: Neutropenia in children with acute leukemia have a high incidence of infection and mortality. To identify and classify the potentially infected pathogens, this study compared the structural characteristics of gut microbiome in neutropenic and non-neutropenic children with acute leukemia. Results: The results showed that 6033 OUTs were observed in total, and the sequence coverage index was more than 0.97. In the analysis of alpha diversity, the colony richness index (Chao1 index) of Group A1 was significantly lower than that of Group A0 (P = 0.035). The fecal bacterial communities were dominated by the phylum Firmicutes, Proteobacteria, and Bacteroidetes in both groups, with no significant difference. Higher relative abundance of genera Enterococcus (P = 0.0076), Streptococcus (P = 0.014) and species Bacteroides fragilis (P = 0.034) were observed in Group A1, but class Clostridia (P = 0.038), genera Blautia (P = 0.021) and Roseburia (P = 0.011) were more prevalent in Group A0. The relatively high abundance of Bacteroides fragilis in neutropenia with childhood acute leukemia was an independent risk factor for infection (P=0.028, 95% CI 1.024-1.241).Conclusions: The increase of Enterococcus, Streptococcus and Bacteroides fragilis, and the decrease of Clostridium, Blautia, and Roseburia may be the characteristics of intestinal flora in patients with acute leukemia. The relatively high abundance of Bacteroides fragilis in neutropenia with childhood acute leukemia may predict the occurrence of infection.

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Treatment outcomes of children with acute lymphoblastic leukemia in a middle-income developing country: high mortalities, early relapses, and poor survival

Cited by 45 publications

References 26 publications

Septicemia after chemotherapy for childhood acute lymphoblastic leukemia in China: A multicenter study CCCG‐ALL‐2015

Septicemia after chemotherapy for childhood acute lymphoblastic leukemia in China: A multicenter study CCCG‐ALL‐2015

Rates and trends of childhood acute lymphoblastic leukaemia: an epidemiology study

Characteristics of Gut Microbiome and Prediction of Infection in Neutropenic Children with Acute Leukemia

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