Improving survival outcomes of childhood acute lymphoblastic leukemia: A 25‐year experience from a single center in Saudi Arabia

Abstract

Introduction:The development of cancer programs in developing countries to meet the standards observed in high-income developed countries is not well documented.Methods: An analysis of patient care of children with acute lymphoblastic leukemia (ALL) at the Princess Noorah Oncology Center over 25 years was performed. A number of improvements were introduced over time including optimizing the cancer care delivery culture, improving access to care, optimizing supportive care, and refining diagnostic and therapeutic capabilities. Outcomes were evaluated over three time periods (period 1, 1989-2000; period 2, 2001-2007; and period 3, 2008-2014). These findings were compared with results of collaborative clinical trials (CCT). Results:Of the 686 patients treated, the five-year overall survival (OS) rate improved from 74% ± 2.7% in period 1 to 89.5% ± 2.3% in period 3 (P < 0.0001). Among all patients, the five-year cumulative incidence of death decreased from 26% in period 1 to 10.5% in period 3 (P < 0.0001). This decrease was mainly due to reduction in the incidence of death from disease (P < 0.00001). In contrast, significant improvement in T-cell ALL survival outcomes (P < 0.0001) was observed overtime (from period 1 to period 3) as a result of significant reduction in both toxic deaths (P = 0.005) and disease-related deaths (P = 0.001). Conclusions:Survival outcomes in Saudi Arabia have improved with five-year OS rate now approaching 90%. However, further population-based research is needed to understand variance in outcomes from those reported by CCT groups. K E Y W O R D Sacute leukemia, ALL, developing country, outcomes research, pediatric Hematology/oncology, treatment

Treatment of Childhood Acute Lymphoblastic Leukemia in Iraq: A 17-Year Experience From a Single Center

“…These results are in keeping with other studies from LMCIs that reported relapse rates of 21.5%, 26% and 58.5% 15,[37][38][39] . In the present study, the CNS relapse rate (isolated 28%; combined 14%) was high, in contrast with a lower frequency in reports that employ CRI prophylaxis for HR children 15,31,32,40,41 . The reasons for this unfavorable result could be multiple, including inaccurate diagnosis of CNS involvement at diagnosis (CSF analysis not available in 243 patients), less intensive systemic therapy and finally biologic differences in relapsed patients.…”

A clinical approach to non-neutropenic fever in children with cancer

“…All patients treated at PNOC had access to the Pediatric Oncology Walk-In Emergency unit, which provides 24/7 open direct access to oncology patients for treatment at PNOC. 28 Patients presenting themselves with NNF at this unit were assessed for any focus of infection, had their central and/or peripheral blood cultures drawn, and started on antibiotic (ceftriaxone) monotherapy intravenously daily with daily follow-up at the outpatient clinic, pending the blood culture results following a local standard clinical pathway. Therapy was continued until fever resolution or tailored based on the patient’s blood culture results or clinical progress during daily visits.…”

Epidemiological Trends and Clinical Characteristics of Childhood Leukemia in Saudi Arabia: A Review

“…The significant facilitated improvements in B-cell ALL pediatric outcomes over time were mainly attributed to therapeutic and service measures. Ensuring easier access to medical care, standardization of treatment protocols, environmental control measures, and standard febrile neutropenia protocol, utilizing proper flowmetry techniques to successfully monitor minimal residual disease (MRD) and advances in intensive supportive care were among the implementations employed judiciously to minimize the incidence of leukemia death among children [ 13 ].…”