The role of routing in the diagnosis of acute leukemia in children: an observational retrospective non-randomized study

Abstract

Introduction. Acute leukemia (AL) is the commonest malignancy of childhood. Early diagnosis of AL is difficult due to the non-specificity of primary symptoms, which are often hidden under the "masks" of other diseases. Aim. Assess the delay in diagnosis depending on the areas of residence in the Tver region and area remoteness from the Tver Regional Clinical Children's Hospital. Materials and methods. The analysis included 35 patients hospitalized in the Department of Oncology and hematology of the RCCH for the period from 2018 to 2023. The diagnoses were: ALL - 30 (86%), AML - 3 (9%), and AL of unspecified cell type (ALUCL) - 2 (5%) patients. The mean age was 61 months. Thrombocytopenia and anemia at the time of diagnosis were found in 76% and 78%, respectively. Leukocytosis 20 x 109/L was observed in 58%, leukopenia 3.5 x 109/L in 15% of patients. In 97% of cases blasts (2% to 95%) were detected in peripheral blood. In the city of Tver (group 1) and the Tver region (group 2), 16 (46%) and 19 (54%) patients were identified, respectively. The mean age of patients in group 1 is 28.6 months, and in group 2 - 72.3 months (p = 0.1). Results. In group 1 and 2, ALL was diagnosed in 14 (88%) and 16 (84%), AML in 1 (6%) and 2 (11%) and ALUCL in 1 (6%) and 1 (5%) cases, p = 0.6, 0.7 and 0.95, respectively. Delay of diagnosis in the general group (n = 35) was observed 2 weeks in 21 (60%) cases, 2-4 weeks - in 7 (20%), ≥4 - ≤ 8 weeks - in 4 (11%) and 8 weeks - in 3 (9%) cases. Delayed diagnosis among patients living in the city of Tver and Tver region was observed 2 weeks in 7 (44%) vs. 13 (68%) cases, 2-4 weeks - in 6 (38%) vs 3 (17%), ≥4 - ≤ 8 weeks - in 1 (6%) vs 1 (5%) and 8 weeks - in 2 (12%) vs 2 (10%) cases, respectively (p = 0.37). There was no significant impact of the distance of the residence place from the level 3 children's hospital providing specialized care (RCCH) on the time of diagnosis. Conclusion. The distance from the third-level hospital did not affect the period of diagnosis of AL in children.