Long-term outcome of childhood acute lymphoblastic leukemia treated in China.

BACKGROUND

To retrospectively determine the treatment outcome and causes of treatment failure of ALL children treated in a single institution at East China.

PROCEDURE

Between January 1998 and October 2004, 346 newly diagnosed ALL patients <or=16 years were admitted to our hospital. Of these, 248 patients received modified National Protocol of Childhood ALL in China 1997 (NPCAC97) for at least 2 weeks of treatment and were eligible for protocol evaluation.

RESULTS

Among the 346 newly diagnosed patients, 167 (48.3%) stopped treatment either at diagnosis or during therapy. The abandonment rates for urban area group (UAG) and rural area group (RAG) were 25.3% and 57.3%, respectively (P < 0.0001). The 5-year event-free survival (EFS) rate for the entire cohort was 38.5 +/- 2.7%. For 248 evaluable patients, the remission rate was 97.2%. The 5-year EFS and overall survival (OS) rates were 70.7 +/- 3.6% and 82.1 +/- 3.0%, respectively. The 5-year EFS for standard-risk group (n = 196) was significantly higher than that of high-risk group (n = 52) (75.9 +/- 3.9% vs. 50.7 +/- 8.0%, P = 0.0002). Prognostic factor analysis showed that poor response to remission induction therapy and a poor socioeconomic status were predictive for an inferior outcome.

CONCLUSION

Abandonment of chemotherapy was the most common cause of treatment failure, which was strongly related to poor socioeconomic status and financial support. For patients who could adhere to the treatment protocol, a relatively good outcome was achieved.