Childhood ALL Treatment and Protocol Compliance Failure at a Single Institute from Most Developed Area of China.

Purpose To analyze the main reason of failure in children with ALL at a single institute which is at most developed city of developing country China.

Method All the ALL patients who was diagnosed at our hospital from 1998.10 to 2003.12 were analyzed. The date was created from our department tumor registry database. Patient was divided into 3 groups, high, middle and low risk, depends on 1.Age >=10 year, 2. 50×10⁹/L>WBC<100×10⁹/L, 3. chromosome<45,or DNA index <1.16, 4. t(4;11), 5. T-ALL, 6.CNSL and/or TL, 7. WBC>=100×10⁹/L, 8.t(9;22), 9.<1 year or >12 year, 10. Early response (1) Pred.test day 8,pripherial blast >=1,000/μl, (2) Induction day19–21 or day 35 bone marrow blast >=5%. Anyone from item 1 to 5 was middle risk factor, item 6 to 9 was high risk factor. The patients not receiving any therapy after ALL diagnosis were accounted as early protocol compliance failure, receiving therapy less than 15 days were middle protocol compliance failure, giving up therapy or losing follow-up after 15 day with stable disease or CR were accounted as late compliance failure.

Results Total 224 ALL were diagnosed, of them 38 patients went home with no any therapy. That means early protocol compliance failure was 17%. Of the remained 186 patients, 26 patients(12%) belonged to middle protocol compliance failure and 6 (3%) was late compliance failure. So total protocol compliance failure was 31%. The main reason of compliance failure was lacking financial support. Within the 160 patients who received more than 15 days therapy, 50(31%) was high risk, 51(32%) middle risk, and 52(33%) low risk, another 7 at un-know risk group. Of them, 48 patients relapsed(40) or not reached CR(8), 10 died of complication(mainly infection), total treatment failure was 48(30%).

Conclusion Besides the treatment failure, protocol compliance failure is a important reason for childhood ALL survival failure in developing country.