3-year survival rate in acute lymphoblastic leukemia: comparison of ALL-2006 and ALL-2013 Protocols

Abstract

Background With advances in supportive and risk-stratified therapy, the 5-year survival rate of acute lymphoblastic leukemia has reached 85.5%. The ALL-2006 treatment protocol was modified and renamed the ALL-2013 protocol, with dose and duration changes.
 Objective To compare outcomes of the ALL-2006 and ALL-2013 protocols, with regards to mortality, remission, relapse, and three-year survival rates.
 Methods This was retrospective cohort study. Subjects were acute lymphoblastic leukemia (ALL) patients treated from 2011 to 2018 in Mohamad Hoesin Hospital, Palembang, South Sumatera. The three-year survival rates, relapse, remission rates and comparison of ALL-2006 and ALL-2013 protocols were analyzed with Kaplan-Meier method.
 Results Mortality was significantly correlated with age at diagnosis <1 year and >10 years, hyperleukocytosis, and high-risk disease status. Patients aged 1 to 10 years, with leukocyte count <50,000/mm3 and standard-risk status had significantly higher likelihood of achieving remission. Mortality was not significantly different between the ALL-2006 protocol group [70.6%; mean survival 1,182.15 (SD 176.89) days] and the ALL-2013 protocol group [72.1%; mean survival 764.23 (SD 63.49) days]; (P=0.209). Remission was achieved in 39.2% of the ALL-2006 group and 33% of the ALL-2013 group (P>0.05). Relapse was also not significantly different between the two groups (ALL-2006: 29.4% vs. ALL-2013: 17.9%; P>0.05). Probability of death in the ALL-2006 group was 0.3 times lower than in the ALL-2013 group (P<0.05), while that of the high-risk group was 3 times higher. Remission was 2.19 times higher in those with leukocyte <50,000/mm3 compared to those with hyperleukocytosis. In addition, relapse was significantly more likely in high-risk patients (HR 2.96; 95%CI 1.22 to 7.19). Overall, the 3-year survival rate was 33%, with 41.7% in the ALL-2006 group and 30.7% in the ALL-2013 group.
 Conclusion Three-year survival rate of ALL-2006 protocol is higher than that of ALL-2013 protocol but is not statistically significant. Age at diagnosis <1 year and >10 years, hyperleukocytosis, and high-risk group are significantly correlated with higher mortality and lower remission rates. However, these three factors are not significantly different in terms of relapse.

The incidence and mortality of childhood acute lymphoblastic leukemia in Indonesia: A systematic review and meta-analysis

“…Eight studies provided details on the number of deaths in childhood ALL. The mortality rate was highest in a study from Palembang [ 44 ], with 5.3 deaths per 100,000 children. Meanwhile, the lowest mortality rate was given in a study in Jakarta [ 39 ], with 0.44 deaths per 100,000 children.…”

“…The mortality of childhood ALL ranges from 0.44 deaths per 100,000 children in one study [ 39 ] to 5.3 deaths per 100,000 children in another study [ 44 ]. The CFR in this study is 3.58%.…”

“…Regarding selective outcome and analysis reporting, some studies do not include the full ALL population available due to the inclusion and exclusion criteria [ 41 , 43 , 44 ]. One glaring difference can be found in a study conducted by Samosir et al [ 43 ] in which only 49 children were included out of 495 newly-diagnosed cases of childhood ALL.…”

Survival and Treatment Outcomes of Childhood Acute Lymphoblastic Leukemia in a Low-Middle Income Country: A Single-Center Experience in West Java, Indonesia

“…This is consistent with the previous studies conducted in several cities in Indonesia, which showed that the survival rate of ALL in children ranges from 20% to 60%. [12][13][14] The survival rate in low-middle-income countries based on CONCORD-2 data was 34.3-73.1%. 2,15 Neutropenia was the main cause of death-related treatment enhanced by infection, leading to life-threatening conditions requiring further treatment and may contribute to the delay of therapy during the induction phase.…”

Pengaruh Toksisitas Hematologi Fase Konsolidasi Terhadap Kesintasan Pasien Leukemia Limfoblastik Akut di Rumah Sakit Umum Daerah Dr. Moewardi Surakarta

“…Overall survival berdasarkan subjek yang mengalami toksisitas kemoterapi hematologi derajat ringan-sedang adalah 64%, sedangkan derajat berat adalah 41%. Angka ini lebih tinggi bila dibandingkan dengan penelitian di Palembang oleh Meirizkia dkk 16 melaporkan secara keseluruhan, tingkat kelangsungan hidup 3 tahun adalah 33%, dengan 41,7% pada kelompok LLA-2006 dan 30,7% pada kelompok LLA-2013. Penelitian tahun 2018 di Makassar selama 4 tahun (48 bulan) pasien LLA pada anak di RSUP Dr. Wahidin Sudirohusodo sebesar 26%.…”