Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Pediatrics Department, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran.
Cancer Rep (Hoboken). 2023 Apr;6(4):e1784. doi: 10.1002/cnr2.1784. Epub 2023 Jan 26.
The survival of childhood leukemia has improved. We aimed to report the survival rate and the associated factors in children with acute leukemia during an 8-year follow-up.
This study investigates the 8-year survival rates of children with acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) in Shiraz, the largest oncology center in Southern Iran. We also aimed to assess the independent factors associated with higher mortality in childhood leukemia.
Children 0-18 years with acute leukemia were followed from 2013 to 2021 in Shiraz, Iran. The 8-year overall survival (OS) and event-free survival (EFS) rates were estimated by the Kaplan-Meier method. Independent factors associated with survival were assessed by the Cox regression hazard modeling.
We included 786 children, with 43.5% female, and a mean age of 6.32 ± 4.62 years. Patients with AML compared to ALL experienced more relapse (34.6% vs. 22.5%, p = .01) and death (31.7% vs. 11.3%, p < .001). The cumulative 8-year OS and EFS were 81% (95% confidence interval (CI), 74.3% to 86.1%) and 68.3% (95% CI, 63.5% to 72.7%) in ALL patients and 63.5% (95% CI, 52.1% to 72.9%) and 43% (95% CI, 33.1% to 52.6%) in AML patients. Multivariable analysis revealed that hepatomegaly (hazard ratio = 4, 95% CI, 1.0 to 22.3, p = .05) was the main independent risk factor of death in ALL patients. No definite risk factor was defined for AML patients.
The survival of childhood leukemia has recently increased dramatically in low-middle income countries. Hepatomegaly was introduced as a potential risk factor for lower survival in ALL patients. Further multicenter studies are needed to confirm the validity of this association.
儿童白血病的存活率有所提高。我们旨在报告 8 年随访期间儿童急性白血病的存活率及其相关因素。
本研究调查了伊朗南部最大的肿瘤中心设拉子地区儿童急性髓系白血病（AML）和急性淋巴细胞白血病（ALL）的 8 年存活率。我们还旨在评估与儿童白血病死亡率较高相关的独立因素。
2013 年至 2021 年，在伊朗设拉子对 0-18 岁患有急性白血病的儿童进行了随访。通过 Kaplan-Meier 法估计 8 年总生存率（OS）和无事件生存率（EFS）。通过 Cox 回归风险建模评估与生存相关的独立因素。
我们纳入了 786 名儿童，其中 43.5%为女性，平均年龄为 6.32±4.62 岁。与 ALL 相比，AML 患者经历更多的复发（34.6%比 22.5%，p=0.01）和死亡（31.7%比 11.3%，p<0.001）。ALL 患者的累积 8 年 OS 和 EFS 分别为 81%（95%置信区间（CI）：74.3%至 86.1%）和 68.3%（95%CI：63.5%至 72.7%），AML 患者的分别为 63.5%（95%CI：52.1%至 72.9%）和 43%（95%CI：33.1%至 52.6%）。多变量分析显示，肝肿大（危险比=4，95%CI：1.0 至 22.3，p=0.05）是 ALL 患者死亡的主要独立危险因素。AML 患者没有明确的危险因素。
近年来，中低收入国家儿童白血病的存活率有了显著提高。肝肿大被认为是 ALL 患者生存率较低的一个潜在危险因素。需要进一步的多中心研究来证实这种关联的有效性。
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