Prognostic Factors and Survival Rate of Childhood Acute Lymphoblastic Leukemia in Eastern Indonesia: Kaplan–Meier and Cox Regression Approach

Abstract

BACKGROUND: Acute lymphoblastic leukemia (ALL) is one of the most common childhood hematological malignancies with an incident each year that tends to increase.
 AIM: This study aims to determine the survival rate of childhood ALL in Dr. Wahidin Sudirohusodo General Hospital and the prognostic factors that influence it.
 METHODS: A retrospective cohort design was conducted among childhood ALL. The samples were patients ALL diagnosed since January 1, 2014, until 31, 2017, in Dr. Wahidin Sudirohusodo General Hospital. A total of 109 patients were selected by simple random sampling. Data collected through medical records observations. Data were analyzed using Kaplan–Meier and Cox regression analysis.
 RESULTS: The cumulative survival rate of childhood ALL was 26%. The prognostic factors associated with survival of childhood ALL were nutritional status (p = 0.028), leukocyte counts (p = 0.000), platelet counts (p = 0.000), and comorbidity (p = 0.000). Based on multivariate analysis with Cox regression, the most influencing prognostic factor on survival of ALL patients was comorbidity (p = 0.000, hazard ratio = 3.699 confidence interval 95% 1.945–7.033). Childhood ALL with comorbidities had a risk of death 3699 times higher than childhood ALL without comorbidities.
 CONCLUSION: Nutritional status, leukocyte counts, platelet counts, and comorbidity were prognostic factors that influence survival of childhood ALL. Comorbidity was the most influencing prognostic factor on survival of childhood ALL.