Treatment outcomes in childhood acute lymphoblastic leukemia: 40-year experience from a single tertiary center in Thailand

Abstract

Studies on the long-term treatment outcomes of childhood acute lymphoblastic leukemia (ALL) in resource-limited countries are scarce. The purpose of this study was to assess the evolution of survival outcomes of pediatric ALL in a tertiary care center in Thailand over a 40-year period. We retrospectively reviewed the medical records of pediatric patients who were diagnosed with ALL and treated at our center between June 1979 and December 2019. We classified the patients into 4 study periods depending on the therapy protocol used to treat the patients (period 1: 1979–1986, period 2: 1987–2005, period 3: 2006–2013, and period 4: 2014–2019). The Kaplan–Meier method was used to determine overall and event-free survival (EFS) for each group. The log-rank test was used to identify statistical differences. Over the study period, 726 patients with ALL were identified, 428 boys (59%) and 298 girls (41%), with a median age at diagnosis of 4.7 years (range: 0.2–15 years). The study periods 1, 2, 3, and 4 had 5-year EFS rates of 27.6%, 41.6%, 55.9%, and 66.4%, and 5-year overall survival (OS) rates of 32.8%, 47.8%, 61.5%, and 69.3%, respectively. From periods 1 to 4, both the EFS and OS rates increased significantly (p <. 0001). Age, study period, and white blood cell (WBC) count were all significant prognostic indicators for survival outcomes. The OS of patients with ALL treated in our center improved significantly over time from 32.8% in period 1 to 69.3% in period 4.

Keywords:

• Acute lymphoblastic leukemia
• childhood leukemia
• long-term treatment outcome

Acknowledgments

Assistance provided by Mr. Dave Patterson with English editing was greatly appreciated.

Authorship contributions

This manuscript has not been previously published and is not currently being submitted to any other journals. All authors contributed significantly to the study and read and approved the final draft. There are no financial or commercial interests in this work. All authors made major contributions to this study and they all evaluated and approved the final version.

Conflict of interest statement

There are no conflicts of interest reported by the authors.

Data availability statement

Data supporting the conclusions of this investigation are available upon reasonable request from the corresponding author. The information is not publicly available due to privacy and ethical considerations.