Outcome of Childhood Acute Lymphoblastic Leukemia Treated Using the Thai National Protocols

Seksarn, Panya; Wiangnon, Surapon; Veerakul, Gavivann; Chotsampancharoen, Thirachit; Kanjanapongkul, Somjai; Chainansamit, Su-On

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자료유형: 학술저널

저자정보: Seksarn, Panya (Division of Hematology/Oncology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University) Wiangnon, Surapon (Division of Pediatric Hematology/Oncology, Department of Pediatrics, Faculty of Medicine, Khon Kaen University) Veerakul, Gavivann (Division of Pediatric Hematology/Oncology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University) Chotsampancharoen, Thirachit (Department of Pediatrics, Faculty of Medicine, Prince of Songkla University) Kanjanapongkul, Somjai (Queen Sirikit National Institute of Child Health) Chainansamit, Su-On (Department of Pediatrics, Khon Kaen Hospital)

저널정보: 아시아태평양암예방학회 Asian Pacific journal of cancer prevention : APJCP Asian Pacific journal of cancer prevention : APJCP 제16권 제11호

발행연도: 2015.1

수록면: 4,609 - 4,614 (6page)

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Background: In recent decades, the prognosis for childhood leukemia has improved, especially for acute lymphoblastic leukemia (ALL). In Thailand, though, the survival rate for ALL is unimpressive. In 2006, standard national protocols for childhood leukemia treatment were implemented. We herein report the outcome of the ALL national protocols and explanations behind discrepancies in outcomes between institutions. Materials and Methods: Between March 2006 and February 2008, 486 children with ALL from 12 institutions were enrolled in the Thai national protocols. There were 3 different protocols based on specific criteria: one each for standard risk, high risk and Burkitt's ALL. We classified participating centers into 4 groups of institutions, namely: medical schools in Bangkok, provincial medical schools, hospitals in Bangkok and provincial hospitals. We also evaluated supportive care, laboratory facilities in participating centers, socioeconomics, and patient compliance. Overall and event-free survival were determined for each group using the Kaplan Meier method. Statistical differences were determined using the log-rank test. Previous outcomes of Thai childhood ALL treatment between 2003 and 2005 served as the historic control. Results: Five-year overall survival of ALL treated using the Thai national protocol was 67.2%; an improvement from the 63.7% of the 12-institute historical control (p-value=0.06). There were discrepancies in event-free survival of ALL between centers in Bangkok and up-country provinces (69.9% vs 51.2%, p-value <0.01). Socioeconomics and patient compliance were key elements in determining the outcome (65.5% vs 47.5%, 59.4% vs 42.9%) (p-value < 0.02). Conclusions: Implementation of standard national protocols for childhood leukemia in Thailand did not significantly improve the outcome of ALL. Factors leading to better outcomes included (a) improvement of treatment compliance (b) prevention of treatment abandonment and (c) financial support to the family.

#Acute leukemia #children #national protocols #Thailand

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Seksarn, Panya

소속기관 Division of Hematology/Oncology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn Univer