Risk Factors for Relapse in Childhood Acute Lymphoblastic Leukemia
Abstract
ABSTRACT
Background: Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy and has a very good outcome especially in the developed countries. However, relapse (medullary and extramedullary) is still an important obstacle to fully successful treatment.
Objectives: To figure out if there are predictive factors of ALL relapse in our practice using some clinical and laboratory features
Methods: A retrospective study was conducted on 168 patients below 15 years who were admitted to the Child’s Central teaching hospital, Baghdad, Iraq. They were newly diagnosed as acute lymphoblastic leukemia (ALL-L3 patients were excluded) in the period from 1st April 2008 to 31st December 2011. They were treated according to the modified UKALL protocol and were stratified initially either to group A (age >1 and <10 years and initial WBC count <50 x 109/L) and were considered as standard-risk (SR) or group B (for remaining patients) and were considered as high-risk (HR).
Results: Out of the 168 eligible ALL patients, 25 (14.9%) patients did not start induction therapy (15 (8.9%) patients refused treatment, 7 (4.2%) patients died before induction and 3 (1.8%) patients were referred to other centers). So, 143 patients started the induction phase of the modified UKALL protocol; 6 (4.2%) of them died during induction and 7 (4.9%) abandoned treatment. One hundred and thirty (90.9%) patients achieved first complete remission (CR1) after 28-35 days of induction therapy. Out of them, 13 (10%) patients died while in CR1 and 4 (3.1%) abandoned treatment in CR1. Twenty five (19.2%) patients experienced medullary and/or extramedullary relapses and till last day of follow-up 88 (67.7%) patients remained in CCR1.
Conclusion: Medullary and extramedullary relapses are the most common causes of treatment failure for ALL children who achieved CR1, and CNS relapse is the most common type. Male gender, infants, adolescents and initial CNS involvement are significant risk factors. High initial WBC count is not a clear risk factor
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