Therapy Outcome in Childhood ALL: Experience from a Tertiary Care Centre in North India.

Survival in childhood ALL, in resource challenged nations, has not kept pace with cure rates of over 80% in developed countries. This descriptive study was designed to assess survival data and identify risk factors for adverse outcome. Data obtained from case records of 762 patients with ALL was analyzed. Information regarding the clinical-demographic profile, therapy and course of illness were recorded. Status and duration at last follow-up were utilized to generate Kaplan-Meier survival curves. The mean age at presentation was 5.7±0.23 years (M:F::3.2:1). Caretakers of 230 (30.2%) patients opted for no therapy. There were 68 and 60 deaths in induction and remission phases respectively. Besides these, 111 children either defaulted therapy (23) or were lost to follow up (88). Relapsed disease was documented in 125 cases. The 5 year overall and event-free survival was 46 and 34% respectively. The p values for survival analysis using the Log-rank test for groups formed according to the gender, age, symptom-diagnosis interval, TLC and platelet count were 0.19, 0.02, 0.08, <0.001, 0.001 respectively. Bulk disease (p=0.047), mediastinal adenopathy (p=0.045), TLC (p=0.016), platelet count (p=0.031) and administration of 2 intensification blocks (p=0.012) were found to be significant predictors of outcome by univariate and multivariate analysis. The holistic management of ALL in children requires financial resources, a strong psychosocial structure and access to quality supportive care. Almost one third of our patients opted for no therapy. The other problem areas identified were a high proportion of therapy defaulters, lost to follow up and infection related deaths during induction and remission phases. TLC >50000/microliter and platelet count <30000/microliter had an adverse impact on survival. The administration of both early and delayed intensification improved survival. The introduction of remedial measures for tapping the difficulties identified, would undoubtedly improve cure rates in children with ALL in developing nations.