Abstract
BackgroundEven though the treatment outcomes of childhood acute lymphoblastic leukemia (ALL) have improved recently, relapse of the disease still remains a challenge in developing countries. This study aims to analyze the incidence of relapse and survival rates in childhood ALL.MethodsA retrospective study of 156 children with de novo ALL between 2012-2018 was conducted. Data on age, gender, relapse type, and relapse time were analyzed.ResultsA total of 26 (16.7%) patients experienced relapse, with a male-to-female ratio of 2.71:1. The relapse rate in the high-risk group was 1.6 times greater than that in the standard-risk group (61.5% vs. 38.5%). The median time from diagnosis to relapse was 29.3 months (38.5% in the early stage, 26.9% in the intermediate, and 34.6% in the late stage). The most common relapse site was bone marrow (38.5%), followed by the isolated central nervous system (CNS, 23.1%) and CNS plus bone marrow (23.1%); the least common site was testicle with or without bone marrow or CNS (15.2%). The median post-relapse survival time was 7.5 months.ConclusionModification of the protocol to use escalated methotrexate dose and providing new therapies such as stem cell transplantation can improve the overall survival rates in relapsed ALL patients.
Highlights
Acute lymphoblastic leukemia (ALL) is the most common malignant disease in children
The relapse rate in the high-risk group was 1.6 times greater than that in the standard-risk group (61.5% vs. 38.5%)
Our study showed a relapse rate of 16.7%, which is higher compared to findings of studies by Locatelli et al and Oskarsson et al [3,4], but lower than in studies by Ali et al and Nguyen et al, which reported relapse rates of 24.5% and 20.5%, respectively [5,6]
Summary
Acute lymphoblastic leukemia (ALL) is the most common malignant disease in children. It accounts for onefourth of all childhood cancers and 72% of all cases of childhood leukemia. Its incidence is estimated to be two to five per 100,000 children. With the recent advances in chemotherapy, hematopoietic stem cell transplant, and supportive care, the long-term survival in childhood ALL has increased to 85-90%. Even though the treatment outcomes of childhood acute lymphoblastic leukemia (ALL) have improved recently, relapse of the disease still remains a challenge in developing countries. This study aims to analyze the incidence of relapse and survival rates in childhood ALL
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