Contributions
Abstract: PB1367
Type: Publication Only
Session title: Acute lymphoblastic leukemia - Clinical
Background
Acute leukemia (AL) is the most common form of pediatric cancer. Nowadays, it is curable in the majority of pediatric patients, with 95% achieving long-term remission. The two most common subtypes of AL in children are Acute Lymphoblastic Leukemia (ALL) and Acute Myeloid Leukemia (AML).
Aims
to report the epidemiology and treatment outcome of children with AL in our center.
Methods
This was a retrospective study. The available data were retrieved from medical files of children newly diagnosed with AL during the period from 1st January 2013 to 31st December 2018 at Alexandria University Children's Hospital, a large tertiary care center in northern Egypt. The demographic, initial clinical, and laboratory data were collected, as well as the treatment protocol and outcome of included patients.
Results
A total of 413 patients was identified during the study period, of which 98 have been transferred to a central children's cancer hospital in Cairo, and 315 were treated and further analyzed. The patients' age ranged from 2.0 to 288 months, the majority of patients were from 1-10 years of age, 19 (6%) patients were more than ten years of age, and 13 (4.1%) patients were less than one year of age. One hundred sixty eight (53.3%) patients were males, while the females represented 147 (51.1%) patients. Two hundred fifty seven (81.6%) patients had ALL and 58 (18.4%) patients had AML. At presentation, the median total leucocytic count was 12.0 x103/µL, ranging from 0.2 - 989 x103/µL; 37 (11.7%) patients had hyperleukocytosis. From 2013 to 2016, ALL patients were treated according to the modified CCG-1991 standard risk protocol and CCG-1961 high-risk protocol, then Total study XV protocol was used starting in 2017. AML patients were treated according to the MRC 12 protocol. Regarding patients’ outcome, 128 (49.8%) of ALL patients were in remission after treatment, 56 (21.8%) were on treatment, 57 (22.2%) have died, 9 (3.5%) died after relapse, 6 (2.3%) relapsed on treatment and 1 (0.4%) patient had a therapy-induced AML. Among the AML patients, 21 (36.2%) patients were in remission after end treatment, 3 (5.2%) still on treatment, 27 (46.6%) died, 6 (10.3%) died after relapse, and one (1.7%) patient has been lost to follow up, which significantly worse outcome than ALL patients, (p<0.001*). Only 6.7% of patients relapsed over the study period; hematological relapse was the most common form (71%). Using the Kaplan-Meier survival curve, the 3-years overall survival for all treated patients was 70.4%. Early deaths were more marked among infant leukemia and AML patients, and the most common cause of death among all categories was infectious complications. The 3-years overall survival for ALL patients was 76.4% versus 43.2% in AML patients (p<0.001*). Among ALL patients, B-ALL had a higher 3-year event-free survival (75.3%) compared to T-ALL (58.8%), p = 0.035.
Conclusion
This study showed the distribution of patients treated in our center, showing high mortality, especially early in the treatment of high-risk categories, identifying the areas where improvement of patient care can lead to improvement of survival rates. The relapse rate was not high but might be underestimated by the follow-up period's relatively short duration.
Keyword(s): Acute leukemia, Pediatric, Relapse, Survival
Abstract: PB1367
Type: Publication Only
Session title: Acute lymphoblastic leukemia - Clinical
Background
Acute leukemia (AL) is the most common form of pediatric cancer. Nowadays, it is curable in the majority of pediatric patients, with 95% achieving long-term remission. The two most common subtypes of AL in children are Acute Lymphoblastic Leukemia (ALL) and Acute Myeloid Leukemia (AML).
Aims
to report the epidemiology and treatment outcome of children with AL in our center.
Methods
This was a retrospective study. The available data were retrieved from medical files of children newly diagnosed with AL during the period from 1st January 2013 to 31st December 2018 at Alexandria University Children's Hospital, a large tertiary care center in northern Egypt. The demographic, initial clinical, and laboratory data were collected, as well as the treatment protocol and outcome of included patients.
Results
A total of 413 patients was identified during the study period, of which 98 have been transferred to a central children's cancer hospital in Cairo, and 315 were treated and further analyzed. The patients' age ranged from 2.0 to 288 months, the majority of patients were from 1-10 years of age, 19 (6%) patients were more than ten years of age, and 13 (4.1%) patients were less than one year of age. One hundred sixty eight (53.3%) patients were males, while the females represented 147 (51.1%) patients. Two hundred fifty seven (81.6%) patients had ALL and 58 (18.4%) patients had AML. At presentation, the median total leucocytic count was 12.0 x103/µL, ranging from 0.2 - 989 x103/µL; 37 (11.7%) patients had hyperleukocytosis. From 2013 to 2016, ALL patients were treated according to the modified CCG-1991 standard risk protocol and CCG-1961 high-risk protocol, then Total study XV protocol was used starting in 2017. AML patients were treated according to the MRC 12 protocol. Regarding patients’ outcome, 128 (49.8%) of ALL patients were in remission after treatment, 56 (21.8%) were on treatment, 57 (22.2%) have died, 9 (3.5%) died after relapse, 6 (2.3%) relapsed on treatment and 1 (0.4%) patient had a therapy-induced AML. Among the AML patients, 21 (36.2%) patients were in remission after end treatment, 3 (5.2%) still on treatment, 27 (46.6%) died, 6 (10.3%) died after relapse, and one (1.7%) patient has been lost to follow up, which significantly worse outcome than ALL patients, (p<0.001*). Only 6.7% of patients relapsed over the study period; hematological relapse was the most common form (71%). Using the Kaplan-Meier survival curve, the 3-years overall survival for all treated patients was 70.4%. Early deaths were more marked among infant leukemia and AML patients, and the most common cause of death among all categories was infectious complications. The 3-years overall survival for ALL patients was 76.4% versus 43.2% in AML patients (p<0.001*). Among ALL patients, B-ALL had a higher 3-year event-free survival (75.3%) compared to T-ALL (58.8%), p = 0.035.
Conclusion
This study showed the distribution of patients treated in our center, showing high mortality, especially early in the treatment of high-risk categories, identifying the areas where improvement of patient care can lead to improvement of survival rates. The relapse rate was not high but might be underestimated by the follow-up period's relatively short duration.
Keyword(s): Acute leukemia, Pediatric, Relapse, Survival