Event Free Survival and Overall Survival in Adolescents with Acute Lymphoblastic Leukemia: A Retrospective Review

Abstract

Aim The therapeutic progress achieved with pediatric regimens in childhood acute lymphoblastic leukemia (ALL) has contributed to the increase of their use in adolescents and young adults (AYA) worldwide, in an attempt to achieve a better event free survival and overall survival in AYA’s with ALL. The outcome of AYA’s with ALL has not been published in Lebanon, neither has the therapy related complications, morbidity and mortality rate. Hence, we decided to conduct a retrospective chart review to include all adolescents aged 12-18 years old, diagnosed with ALL, treated at Children’s Cancer Center of Lebanon, based on the “CCCL/ALL I Study for newly diagnosed patients with Acute Lymphoblastic Leukemia”, enrolled since October 2011 until March 2019. Materials and Methods A retrospective chart review was carried on all adolescents aged 12-18 years old, diagnosed with ALL, treated at Children’s Cancer Center of Lebanon, based on the “CCCL/ALL I Study for newly diagnosed patients with Acute Lymphoblastic Leukemia”, enrolled since October 2011 until March 2019. Data collected included patient’s characteristics (age, gender), leukemia characteristics, MRD at different times, complications during treatment and up to 3 years after ending treatment, in addition to mortality, if present and its causes. Results A total of 38 charts were reviewed, of which 66% of those were males, 79% had B lineage ALL, 13% had T-lineage ALL and 8% had biphenotypic leukemia; none of the patients had CNS disease upon presentation, 3% had testicular involvement upfront. 68% of the patients were stratified as intermediate risk patients, 19% as low risk and 13% as high-risk patients according to the St. Jude consortium classification. With a median follow-up of 5 years, the overall survival was 86%, the relapse rate was 10%. The incidence of pancreatitis and thromboembolic complications was 36% and 30%, respectively. The rate of AVN reached 42% in our patients. Conclusion Adolescents diagnosed with acute lymphoblastic leukemia, in Lebanon, between October 2011 and March 2019, treated as per the CCCL/ALL I Study for newly diagnosed patients with Acute Lymphoblastic Leukemia, based on the SJCRH total XV protocol, showed a similar survival rate in comparison to similarly aged patients treated with other pediatric ALL protocols, worldwide. The complication rate was similar as well, though our patients tended to have a higher incidence of AVN, up to 42%, almost doubling the incidence of AVN in published outcomes of similarly aged patients.