Prognostic Factors and Survival Rate of Childhood Acute Lymphoblastic Leukemia in Eastern Indonesia: Kaplan–Meier and Cox Regression Approach

Arsin A. Arsunan; Rezki Elisafitri; Atjo Wahyu; Aisyah Aisyah

doi:10.3889/oamjms.2020.5230

Authors

Arsin A. Arsunan Department of Epidemiology, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
Rezki Elisafitri Department of Epidemiology, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
Atjo Wahyu Department of Occupational Health and Safety, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
Aisyah Aisyah Department of Agribusiness, Pangkajene Kepulauan Polytechnic Agricultural, Pangkajene, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2020.5230

Keywords:

Acute lymphoblastic leukemia, Survival, Childhood, Prognostic factors

Abstract

BACKGROUND: Acute lymphoblastic leukemia (ALL) is one of the most common childhood hematological malignancies with an incident each year that tends to increase.

AIM: This study aims to determine the survival rate of childhood ALL in Dr. Wahidin Sudirohusodo General Hospital and the prognostic factors that influence it.

METHODS: A retrospective cohort design was conducted among childhood ALL. The samples were patients ALL diagnosed since January 1, 2014, until 31, 2017, in Dr. Wahidin Sudirohusodo General Hospital. A total of 109 patients were selected by simple random sampling. Data collected through medical records observations. Data were analyzed using Kaplan–Meier and Cox regression analysis.

RESULTS: The cumulative survival rate of childhood ALL was 26%. The prognostic factors associated with survival of childhood ALL were nutritional status (p = 0.028), leukocyte counts (p = 0.000), platelet counts (p = 0.000), and comorbidity (p = 0.000). Based on multivariate analysis with Cox regression, the most influencing prognostic factor on survival of ALL patients was comorbidity (p = 0.000, hazard ratio = 3.699 confidence interval 95% 1.945–7.033). Childhood ALL with comorbidities had a risk of death 3699 times higher than childhood ALL without comorbidities.

CONCLUSION: Nutritional status, leukocyte counts, platelet counts, and comorbidity were prognostic factors that influence survival of childhood ALL. Comorbidity was the most influencing prognostic factor on survival of childhood ALL.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Permono B, Ugrasena I. Buku Ajar Hematologi-Onkologi Anak. Jakarta: Ikatan Dokter Anak Indonesia; 2012.

LLS. Fact 2016-2017. New York: Leukemia & Lymphoma Society; 2018.

Kemenkes RI. Control Cancer in Children. Jakarta: Republic of Indonesia’s Ministry of Health; 2016.

Medical Record of Dr. Wahidin Sudirohusodo General Hospital Makassar. Data on Acute Leukemia Inpatient Patients 2012- 2017. Makassar: Dr. Wahidin Sudirohusodo General Hospital Makassar; 2018. https://doi.org/10.15562/jdmfs.v13i3.413

Wirawan. Diagnostic acute lymphocytic leukemia: Morphology, immunophenotype, cytogenetic, and molecular. Majalah Kedokt Indones. 2003;53(1).

Eissa H, Zhou Y, Panetta J, Browne E, Jeha S, Cheng C, et al. The effect of body mass index at diagnosis on clinical outcome in children with newly diagnosed acute lymphoblastic leukemia. Blood Cancer J. 2017;7(2):e531. https://doi.org/10.1038/bcj.2017.11 PMid:28212374

Hoed M, Pluijm SM, de Groot-Kruseman HA, Te Winkel ML, van den Akker EL, Hoogerbrugge P, et al. The negative impact of being underweight and weight loss on survival of children with acute lymphoblastic leukemia. Haematologica. 2015;100(1):62-9. https://doi.org/10.3324/haematol.2014.110668 PMid:25304613

Robison LL. Late effects of acute lymphoblastic leukemia therapy in patients diagnosed at 0-20 years of age. Hematology Am Soc Hematol Educ Program. 2011;2011(1):238-42. https://doi.org/10.1182/asheducation-2011.1.238 PMid:22160040

Sousa DW, Ferreira FV, Félix FH, Lopes MV. Acute lymphoblastic leukemia in children and adolescents: Prognostic factors and analysis of survival. Rev Bras Hematol Hemoter. 2015;37(4):223-9.

Almasi-Hashiani A, Zareifar S, Karimi M, Khedmati E, Mohammadbeigi A. Survival rate of childhood leukemia in Shiraz, Southern Iran. Iran J Pediatr. 2013;23(1):53-8. PMid:23550191

Simanjorang C, Kodim N, Tehuteru E. 5-year survival difference acute lymphoblastic leukemia patients and acute mieloblastic leukemia in children at “Dharmais” cancer hospital, Jakarta, 1997-2008. Indones J Cancer. 2013;7(1):15-21.

Wijayanti LP, Supriyadi E. Faktor prognostics and survival of children acute lymphoblastic leukemia patients in Dr. Sardjito Hospital, Yogyakarta, 2010-2015. Indones J Cancer. 2017;11(4):145-50.

Lins MM, Santos MO, Albuquerque MF, Castro CC, Mello MJ, Camargo B. Incidence and survival of childhood leukemia in Recife, Brazil: A population-based analysis. Pediatr Blood Cancer. 2017;64(8):1-6. https://doi.org/10.1002/pbc.26391 PMid:28000427

Erdmann F, Kaatsch P, Zeeb H, Roman E, Lightfoot T, Schüz J. Survival from childhood acute lymphoblastic leukaemia in West Germany: Does socio-demographic background matter? Eur J Cancer. 2014;50(7):1345-53. https://doi.org/10.1016/j.ejca.2014.01.028

Gelelete CB, Pereira SH, Azevedo AM, Thiago LS, Mundim M, Land MG, et al. Overweight as a prognostic factor in children with acute lymphoblastic leukemia. Obesity (Silver Spring). 2011;19(9):1908-11. https://doi.org/10.1038/oby.2011.195 PMid:21720424

Orgel E, Tucci J, Alhushki W, Malvar J, Sposto R, Fu CH, et al. Obesity is associated with residual leukemia following induction therapy for childhood B-precursor acute lymphoblastic leukemia. Blood. 2014;124(26):3932-8. https://doi.org/10.1182/blood-2014-08-595389 PMid:25349177

Lichtman MA. Obesity and the risk for a hematological malignancy: Leukemia, lymphoma, or myeloma. Oncologist. 2010;15(10):1083-101. https://doi.org/10.1634/theoncologist.2010-0206 PMid:20930095

Asnidar A, Arsunan AA, Ayu EK, Suriah, Muriyati. Knowledge, food intake pattern, and body mass index of overweight and obese adolescent before and after giving social media health education in Bulukumba regency. Indian J Public Health Res Dev. 2018;9(9):160-5. https://doi.org/10.5958/0976-5506.2018.00987.7

Rujkijyanont P, Kaewinsang S, Monsereenusorn C, Traivaree C. Pediatric acute leukemia: The effect of prognostic factors on clinical outcomes at phramongkutklao hospital, Bangkok, Thailand. J Med Assoc Thai. 2014;97(2):S188-95. PMid:25518193

Gupta S, Sutradhar R, Guttmann A, Sung L, Pole JD. Socioeconomic status and event free survival in pediatric acute lymphoblastic leukemia: A population-based cohort study. Leuk Res. 2014;38(12):1407-12. https://doi.org/10.1016/j.leukres.2014.08.017 PMid:25224660

Parvareh M, Khanjani N. The survival of childhood leukemia and its related factors in Kerman, Iran. Iran J Health Sci. 2015;3(4):24-32.

Oudot C, Auclerc MF, Levy V, Porcher R, Piguet C, Perel Y, et al. Prognostic factors for leukemic induction failure in children with acute lymphoblastic leukemia and outcome after salvage therapy: The FRALLE 93 study. J Clin Oncol. 2008;26(9):1496-503. https://doi.org/10.1200/jco.2007.12.2820 PMid:18349402

Kulkarni KP, Marwaha RK, Trehan A, Bansal D. Survival outcome in childhood ALL: Experience from a tertiary care Centre in North India. Pediatr Blood Cancer. 2009;53(2):168-73. https://doi.org/10.1002/pbc.21897

Hadianto MT. Differences in Interleukin-8 Levels in Bacterial Infection and Non-Infection in Leukemia Children with Neutropenia Fever, Thesis. Indonesia: Diponegoro University; 2011.