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CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2018; 39(03): 301-306
DOI: 10.4103/ijmpo.ijmpo_9_17
Original Article

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

Bibin Varghese
Department of Paediatrics, Institute of Child Health, Kottayam, Kerala, India
,
Austoria Abzalon Joobomary
Department of Community Medicine, Government Medical College, Kottayam, Kerala, India
,
P Savida
Department of Paediatrics, Institute of Child Health, Kottayam, Kerala, India
› Author Affiliations Financial support and sponsorship Nil.
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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 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). Conclusions: Overall survival was 40% and event-free survival was 28%. Children with acute malnutrition and a higher white blood cell count were more likely to die during induction. Underweight children, malnourished children, and children with lymphadenopathy had significantly poor chances of surviving 5 years' event free.

Keywords

Acute lymphoblastic leukemia - Kerala - risk-directed therapy - survival


Publication History

Article published online:
17 June 2021

© 2018. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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