An analysis of prognostic factors and the five-year survival rate in childhood acute lymphoblastic leukemia.

BACKGROUND: Acute Lymphoblastic Leukemia (ALL) is the most common malignancy in childhood. With newer drug protocols the five-year survival rate is now close to 80%. Various factors have been reported to be important for prognosis and should be considered when planning MATERIAL/METHODS: In a cross-sectional study, prognostic variables and the five-year survival rate were analyzed. Data regarding demographic characteristics, family and personal history, manifestations at the time of presentation, therapeutic regimens and outcome were collected from the records of 76 ALL patients in treatment five years prior to the study. Two pathologists performed the staging using the morphology method (L1, L2 and L3). RESULTS: Fifty-five subjects (72.5%) survived until the end of the study. One subject succumbed to the rapid fatal course of the disease and 20 others passed away due to relapses or infection during follow-up. CONCLUSIONS: Among all variables a worse prognosis was associated (p<0.05) with WBC counts greater than 50,000/ml at presentation, relapse in the CNS, and relapse in the bone marrow. When Anthracycline was included in the therapeutic regimen, the effect of chemotherapy was more favorable compared to regimens without Anthracycline (p<0.05). Other variables previously reported to have prognostic value, especially age and sex, were not significant in our study (p>0.05). Other factors which might account for a poorer prognosis included the preponderance of L-2 morphology, difficult access to medical care, decreased compliance of families due to exhausted economic and psychological reserves, and inadequate knowledge about the disease course and treatment.

Keywords: Iran - epidemiology