Survival and Treatment Outcomes of Childhood Acute Lymphoblastic Leukemia in a Low-Middle Income Country: A Single-Center Experience in West Java, Indonesia

Abstract

Monika Hasna Ramadhan, Nur Melani Sari, Stanza Uga Peryoga, Susi Susanah Department of Child Health, Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin Hospital, Bandung, IndonesiaCorrespondence: Susi Susanah, Department of Child Health Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin Hospital, Jalan Pasteur No. 38, Bandung, Indonesia, Tel/Fax [phone], Email [email protected]: This study aimed to determine the survival rates and treatment outcomes of patients with childhood Acute Lymphoblastic Leukemia (ALL) in a single-center study at Indonesia.Patients and Methods: Factors contributing to the relapse and survival of ALL in Bandung, Indonesia, were evaluated. Data were collected from the medical record and the Indonesian Pediatric Cancer Registry (IPCAR). Subsequently, univariate and multivariate analyses were evaluated using Cox proportional hazard regression and Kaplan Meier was used for survival analysis. An analytic observational study was conducted on newly diagnosed children aged 1– 18 with ALL from January 2019 to December 2022.Results: A total of 137 children were included in the analysis, 30 (21,9%) were dropped out during treatment and 60.5% died during the study period. Most of the deaths occurred after relapse in 32 (38.5%) with a high early relapse (70.5%), occurring mainly during the maintenance phase (42.4%). At the one-year mark, the observed overall survival (OS) rate was at 36%, while event-free survival (EFS) was lower, at 19%. Univariate Cox regression analysis showed that the leucocyte counts at diagnosis (p=0.005) and response to induction phase (p < 0.008) was associated with the death of ALL. Furthermore, a response to induction phase was significant [hazard ratio 4.67 (CI 95%: 1.64– 13.29); p = 0.004] in the multivariate analysis.Conclusion: In conclusion, this study underscored the persistent challenges of high treatment discontinuation rates and the occurrence of very early relapses in low- to middle-income countries (LMICs), which significantly impacted the OS of children diagnosed with ALL.Keywords: acute lymphoblastic leukemia, children, low-middle income country, relapse, survival

Keywords

• acute lymphoblastic leukemia
• children
• low-middle income country
• relapse
• survival