Background Even though the treatment outcomes of childhood acute lymphoblastic leukemia (ALL) have improved recently, relapse of the disease still remains a challenge in developing countries. This study aims to analyze the incidence of relapse and survival rates in childhood ALL. Methods A retrospective study of 156 children with de novo ALL between 2012-2018 was conducted. Data on age, gender, relapse type, and relapse time were analyzed. Results A total of 26 (16.7%) patients experienced relapse, with a male-to-female ratio of 2.71:1. The relapse rate in the high-risk group was 1.6 times greater than that in the standard-risk group (61.5% vs. 38.5%). The median time from diagnosis to relapse was 29.3 months (38.5% in the early stage, 26.9% in the intermediate, and 34.6% in the late stage). The most common relapse site was bone marrow (38.5%), followed by the isolated central nervous system (CNS, 23.1%) and CNS plus bone marrow (23.1%); the least common site was testicle with or without bone marrow or CNS (15.2%). The median post-relapse survival time was 7.5 months. Conclusion Modification of the protocol to use escalated methotrexate dose and providing new therapies such as stem cell transplantation can improve the overall survival rates in relapsed ALL patients.

Aim. To analyze the common cause of death in childhood acute lymphoblastic leukemia patients. Methods and Materials. A retrospective descriptive study on children with acute lymphoblastic leukemia who died at Hue Central Hospital between 2008 and 2018. All the patients were treated with the same protocol of modified Children’s Cancer Group 1882 and 1881. Results. A total of 238 children with acute lymphoblastic leukemia who were cared for at our center were enrolled. Of these, there were 74 deaths. Among the death group, the male-to-female ratio was 2.7:1. Twenty-six (35.1%) occurred in maintenance phase, 18 (24.3%) occurred in induction phase, and 9 (12.2%) occurred in delayed intensification. Infection was responsible for deaths in 32 of 74 (43.2%) cases. Pseudomonas aeruginosa was found in 3 of 32 infected cases (9.4%) and resistance to almost all antibiotics in our hospital. Relapse, abandonment, and bleeding were documented in 20 (27.0%), 7 (9.5%), and 6 (8.1%) cases, respectively. Twenty-seven (84.3%) patients had absolute neutrophil count <500/µL. Of 32 infectious deaths, pneumonia occurred in 40.6%. Regarding 20 relapse death, bone marrow was the major site of relapse and it occurred in 13 (65%) cases. And there were 65% patients with very early relapse. Conclusions. Infection is the major cause of mortality in acute lymphoblastic leukemia patients in our study. To improve outcome, we should improve supportive care, especially prevention and control infection.

Background: Hue Central Hospital (HCH) plays a key role to treat Acute Lymphoblastic Leukemia (ALL) in the central zone of Vietnam which covers geographically wide areas. Before 2007, the survival rate was very low, and abandonment rate was more than 50%. The aims of this study are to determine the outcome of newly diagnosed children with ALL treated at HCH from June 2007 to December 2017 and to report our experiences in reducing the abandonment.Methods: This is a retrospective review of 238 children with ALL admitted from June 2007 to December 2017. The diagnosis was confirmed by morphological FAB criteria and cytochemistry. Patients were classified as standard risk (SR) or high risk (HR) according to NCI criteria, using modified-CCG-1881 and CCG-1882 protocol. Social supports were provided to patients/families.Results: A total of 238 children with ALL were analyzed with mean age of 4.7 years ranging from 1 month to 16 years. The male to female ratio was 2:1. SR and HR patients were 139 (59%) and 99 (41%) respectively. The overall complete remission (CR) rate on day 28 of induction were 92.1% (SR) and 84.9% (HR). Induction death were 3.6% (SR) and 10.1% (HR). Patients accounted for 44 (18.5%) had relapses which occurred in isolated BM n=12, isolated CNS n=17, combined BM and CNS n=13, isolated testis n=2. Overall survival (OS) at 10 years were 70.7% (SR) and 51.5% (HR). The event-free survival (EFS) at 10 years were 66.1%(SR) and 47.3%(HR). Abandonment cases were 9 (3.8%). Conclusion:With less toxic modified protocol, survival rate has been improved and treatment related mortality was minimized though high relapse rate is still an issue. Abandonment has been reduced successfully with holistic strategies such as financial support, managing family group, providing education, early follow-up of patients who missed appointments and free accommodation near hospital for patients/families.

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Mucopolysaccharidosis is a group of rare metabolic disorders characterized by a deficiency of enzymes in the degradation of glycosaminoglycans. The incomplete degradation process leads to the accumulation of glycosaminoglycans in lysosomes of various tissues, which interferes with cell function. We report three cases that were classified as Hurler—Mucopolysaccharidosis I, Morquio—Mucopolysaccharidosis IV A, and Maroteaux–Lamy—Mucopolysaccharidosis VI. Clinical presentations of these cases vary, depending on each type of enzyme defect. All the patients appeared healthy at birth, and symptoms appear at around 1 or 2 years. Clinical features, radiological findings, and especially enzyme assays have allowed us to establish a definitive diagnosis in these cases. These cases highlight that abnormal clinical symptoms, such as growth failure, coarse facial features, and joint problems, are key points for further investigation relating to mucopolysaccharidosis disease. However, in low- and middle-income countries, it is difficult to have a definitive diagnosis of one of the mucopolysaccharidoses due to lacking enzyme assays.