Treatment outcome of children with acute lymphoblastic leukaemia in HUSM

Introduction
\nAcute lymphoblastic leukaemia is the most common malignant disease in children. There
\nis neither national or international consensus about risk assignment, and no uniformed
\nchemotherapy regime accepted. As a result, it is often difficult to compare the outcome
\nfrom one group with another. In Hospital Universiti Sains Malaysia (HUSM), the
\nchildren were treated using EORTC protocol. Other centers in Malaysia treat childhood
\nALL with different treatment protocol. There was only one formal study reported
\nregarding the outcome of children with ALL in Malaysia. However none comparative
\nstudy of the effectiveness of each treatment protocol carried in Malaysian population.
\nThis study was the first to analyse childhood ALL in HUSM.
\nObjectives
\nThe main objective was to evaluate treatment outcome of children with ALL who
\nreceived chemotherapy at Pediatric Oncology Unit in HUSM. The specific objective was
\nto determine survival rate and risk factors for relapsed ALL and death among children
\nwith ALL treated with EORTC treatment protocol.Methodology
\nThe study was conducted at Pediatric Oncology Unit in HUSM. This was a retrospective
\nstudy involving children with ALL who was diagnosed and treated between I sl January
\n1990 and 31 sl December 2003. Children aged I to 13 years and fulfilled the inclusion and
\nexclusion criteria would be enroll in the study.
\nResults
\nThere were a total of 138 children with diagnosis of ALL and received treatment at
\nPediatric Oncology Unit in HUSM from ISIJanuary 1990 to 31 s1 December 2003. A total
\nof 102 children who fulfilled all inclusion and exclusion criteria were available for
\nfurther review. The mean duration of follow-up was 93 months (SD 40). The minimum
\nfollow-up duration was 37 months and maximum duration was 186 months. Most of
\nrelapse occurred within 2 year after diagnosis. Only 2 cases of relapse occurred 5 years
\nafter diagnosis. Isolated BM relapse (22%) was the most common site of relapse. Overall
\nEFS rate at 1, 3 and 5 years was 81.4% (SE ± 3.9), 59.8% (SE ± 4.9) and 55.3% (SE ±
\n5.0) respectively. Multiple Cox proportional analysis showed children aged, WBC count at diagnosis and
\nearly response to single prednisolone were the significant prognostic factors for the
\noutcome of children with ALL. There was increased risk of poor outcome (relapse or
\ndeath) in children aged at 10 to 13 years at about 4 times (95% CI 1.47; 10.44, p=0.006);
\n2.3 times (95% CI 1.09; 5.00, p=0.030) in children with WBC count at diagnosis more
\nthan 100.0 X103/!lL; and those poor early response to single prednisolone at about 2.6
\ntimes (95% CI 1.28; 5.20, p=0.008).
\nConclusion
\nSurvival in this was comparable to developing countries but study remained low
\ncompared to developed countries. Most of relapse occurred within 2 year after diagnosis
\nwith isolated BM relapse was being the most common site of relapse.

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