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Outcomes of Children treated for Relapsed or Refractory Acute Lymphoblastic Leukaemia: A Single Tertiary Care Centre Experience
  • Mosfer AlMalki,
  • Abdulatef Ahmed Ahmed,
  • Hassan AlTrabolsi
Mosfer AlMalki
King Faisal Specialist Hospital and Research Centre - Jeddah

Corresponding Author:[email protected]

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Abdulatef Ahmed Ahmed
King Faisal Specialist Hospital and Research Centre - Jeddah
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Hassan AlTrabolsi
King Faisal Specialist Hospital and Research Centre - Jeddah
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Abstract

Background: Acute Lymphoblastic Leukaemia (ALL) , most common malignancy amongst children with front-line treatment considered major success, 20% of children predicted to either relapse or show resistance to treatment with reported dismal outcomes. Aim: To evaluate clinical characteristics of children diagnosed with refractory / relapsed ALL and to determine 3-year overall survival ouctomes. Method: Retrospective review of patients (aged 1 -14 years) diagnosed with ALL during the period January 2002 to December 2018, data extracted for details of baseline characteristics at diagnosis and at relapse . Results: Total of 347 newly diagnosed children with ALL identified, three induction failures and 28 relapses, with total 31 patients a cohort relapse rate of 9% observed. The male-to-female ratio observed is 4.16:1 and mean duration of CR1 was 26 months : 15 (48%) relapsing ≤ 18 months,seven (23%) during 18 to 36 months and nine (29%) relapsed > 36 months of IF or CR1.Eighteen patients (62%) had isolated BM relapse, six (20%) patients experience isolated Extra-medullary relapse and five (17%) patients experienced BM with other sites. Three-year Overall Survival (OS) of the cohort was 62.3%, while of those patients who achieved CR post first-salvage therapy 3-year OS of 79.5% observed with a statistically significant difference, p value <0.05 comparing to patients who did not achieve remission post first-salvage therapy (3-year OS: 46.4%). The same statistical difference observed in 3-years OS observed comparing duration of remission of CR prior to relapse: ≤ 18 months: 33.2%; 18 – 36 months: 66.7% and > 36 months: 87.5%; the same trend continued when comparing 3-years OS based on risk stratification at relapse: LR: 83.3%; IR: 80% and HR: 44.8%. Conclusion: Incidence and outcomes reported on this study is comparable to internationally reported data with duration of CR1, risk-stratification at relapse and remission status post-salvage therapy determined as significant prognostic factors for survival. No survivial difference amongst patients who received HSCT after induction to those who received chemotherapy, could be attributed to a smaller sample size warranting a multi-institutional observational study. The findings corroborates with the need for novel therapies and treatment approaches in these group of patients
28 May 2023Submitted to Cancer Reports
06 Jun 2023Submission Checks Completed
06 Jun 2023Assigned to Editor
06 Jun 2023Review(s) Completed, Editorial Evaluation Pending
06 Jun 2023Reviewer(s) Assigned
13 Jul 2023Editorial Decision: Revise Major
10 Aug 20231st Revision Received
22 Aug 2023Submission Checks Completed
22 Aug 2023Assigned to Editor
22 Aug 2023Review(s) Completed, Editorial Evaluation Pending
22 Aug 2023Reviewer(s) Assigned
01 Sep 2023Editorial Decision: Revise Major
19 Sep 20232nd Revision Received
03 Oct 2023Submission Checks Completed
03 Oct 2023Assigned to Editor
03 Oct 2023Review(s) Completed, Editorial Evaluation Pending