Five-Year Survival Rate and the Factors for Risk-Directed Therapy in Acute Lymphoblastic Leukemia

Abstract

Background: Acute lymphoblastic leukemia (ALL) has 5-year survival of more than 90% in many advanced cancer research institutes. However, advanced cancer care is not available to majority of poor in developing countries. The experience of treating such patients in a resource-scarce setting is described herewith. Of the 75 individuals studied, 11% of the children were stunted, >21% were underweight, and 16% of the under-five children had acute malnutrition. Massive hepatosplenomegaly and lymphadenopathy were present in 75% and 77% children, respectively. About 71% patients achieved complete remission (CR). A total of 30 (40%) children lived for >5 years after diagnosis and 21 (28%) of them had event-free 5 years. Weight for height for under-five children ( P = 0.029) and total count ( P = 0.019) were found to be significantly associated with deaths during induction. Weight for age ( P = 0.024), weight for height of under-five children ( P = 0.009), and lymphadenopathy ( P = 0.049) had a strong association with 5-year event-free survival. Using multivariate model, only weight for height among under five remained significantly associated with induction deaths ( P = 0.021) and absence of lymphadenopathy with event-free 5-year survival ( P = 0.042). Context: ALL has 5-year survival of >90% in many advanced cancer research institutes. However, advanced care is not available to majority of poor in the periphery of developing countries. Data available on the survival and the factors affecting the outcome among patients treated in poor resource settings are limited. Aims: This study aims to find the 5-year survival rate and the factors for risk-directed therapy in the region. Settings and Design: Cross-sectional analytical study at a tertiary center of public health in central Kerala. Subjects and Methods: Retrospective analysis of case sheets of 75 children who were treated at the institute from March 2006 to March 2011. Statistical Analysis Used: Univariate and Multivariate analysis using IBM SPSS Statistics for Windows, Version 20.0. Results: : Of the 75 individuals studied, 11% of the children were stunted, >21% were underweight, and 16% of the under-five children had acute malnutrition. Massive hepatosplenomegaly and lymphadenopathy were present in 75% and 77% children, respectively. About 71% patients achieved CR. A total of 30 (40%) children lived for >5 years after diagnosis and 21 (28%) of them had event-free 5 years. Weight for height for under-five children ( P = 0.029) and total count ( P = 0.019) were found to be significantly associated with deaths during induction. Weight for age ( P = 0.024), weight for height of under-five children ( P = 0.009), and ly...

A Literature Review of Racial Disparities in Overall Survival of Black Children With Acute Lymphoblastic Leukemia Compared With White Children With Acute Lymphoblastic Leukemia

“…Evidence also suggests that lower socioeconomic status is associated with race and ethnicity and is a strong predictor of quality of care and access to services for children receiving treatment for ALL (Gupta et al, 2009;Varghese et al, 2018). This socioeconomic disadvantage is linked to racial segregation characterized by fragile social infrastructures and high neighborhood poverty that perpetuated decades of pervasive disparities not limited to health care services (Firebaugh & Acciai, 2016).…”

Clinico-epidemiological features and response in childhood acute lymphoblastic leukemia at regional cancer center of Northeast India

“…[17,18] Regarding early treatment response rates, we found negative day-33 MRD as 73% when compared with morphological complete response (CR) of 83%-94% reported by different studies from India. [10,[17][18][19] It is inappropriate to compare day-33 MRD with morphologic CR, as bone marrow assessment for MRD was not done in majority of those studies which were conducted before the year 2010. Reason for poor early response seen in our study is due to higher proportion of children with HR factors.…”

“…Regarding baseline hemogram, mean hemoglobin level was 6.9 g/dl (SD ±2.6; percentile [1][2][3]- [5-8.8]), mean WBC count was 110 × 10 9 /L (SD ± 150 × 10 9 /L; percentile [1][2][3]-[6022-161,500]), and mean platelet count was 52.8 × 10 9 /L (SD ± 36.5 × 10 9 /L; percentile [1][2][3]- [19,750]).…”

“…Normal cytogenetics was seen in 39 (80%) patients. Seven (14%) patients had HR cytogenetics (t [9,22] in 3 [43%]; t [4,11] in 2 [29%]; and t [1,19] and hypoploidy in 1 case [14%] each). Three (6%) patients had good risk cytogenetics (hyperploidy in two patients and t (12,21) in one patient).…”

Only umbilical cord blood banking for stem cells permissible by the Indian Council of Medical Research

“…The banking of all kinds of SC for research purposes might help India produce alternate treatment methods for diseases such as acute lymphoblastic leukemia. [ 4 ] Hence, we can conclude that this issue still needs further scientific debate and scrutiny after effective communication of the guidelines has been made to reach every medical professional.…”