Survival outcome in childhood ALL: Experience from a tertiary care centre in North India

Kulkarni, Ketan; Marwaha, Ram Kumar; Trehan, Amita; Bansal, Deepak

doi:10.1002/pbc.21897

Cited by 61 publications

(53 citation statements)

References 39 publications

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“…The overall 5-year EFS of 78.7% for our patients was comparable to the 5-year EFS of 75% for patients treated on the CCG-1800 series [6], 76.9% in the TOTAL therapy study 13A at St. Jude Children's Research Hospital [28], and 78% in the BFM 90 [29]. The percentage of patients who relapsed in our study (7.2%) compares favorably with that in many resource-poor countries (17.5%-41.1%) [20,21,30,31]. Our results are similar to those of a recent study from Jordan using St. Jude TOTAL protocols [22].…”

Section: Discussionsupporting

confidence: 73%

Implementation of an intensive risk‐stratified treatment protocol for children and adolescents with acute lymphoblastic leukemia in Lebanon

et al. 2012

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With modern risk-adapted therapy, over 80% of children with acute lymphoblastic leukemia (ALL) in highincome countries (HICs) are cured. In countries with limited resources, however, therapy results for pediatric ALL are still not encouraging. We describe our experience in treating children with ALL using a risk-adapted protocol at a tertiary referral center in Lebanon. From May 2002 to August 2009, 111 consecutive patients 1-21 years of age with newly diagnosed ALL received the CCCL ALL protocol which was based on the St. Jude Children's Research Hospital Total XV Study. The median age at diagnosis was 5 years 5 months. The male to female ratio was 1.5. Forty-six patients received the intermediate-/high-risk arm and 65 received the low-risk arm. Only one patient (0.9%) died during induction therapy. Relapse occurred in 8 (7.2%) patients. Eight (7.2%) patients died, 4 of whom were in remission. The median follow-up of the patients was 38 months. The 5-year overall survival and event-free survival were and 88.5% (95% CI: 77.1-94.4) and 78.7% (95% CI: 69.8-88.4), respectively. Our results are comparable to those in HICs in spite of the limited resources and the relatively low socioeconomic status of the Lebanese population. Children treated on this protocol experienced significant toxicity necessitating expert supportive care, but benefited from improved cure rates and prolonged survival. Am. J. Hematol. 87:678-683, 2012. V

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Section: Discussionsupporting

confidence: 73%

Implementation of an intensive risk‐stratified treatment protocol for children and adolescents with acute lymphoblastic leukemia in Lebanon

et al. 2012

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“…But in resource-poor countries like India, limited availability and high cost of Rasburicase hinders its free use. Non-availability and high cost of dialysis is also a big hurdle in managing patients with TLS [9]. Although without a control group, our study cannot conclude that dialysis can be avoided in such patients, it has shown that sevelamer is equally useful in aggressive tumours like Burkitt's lymphoma.…”

Section: Discussionmentioning

confidence: 70%

“…In the developing world induction mortality is high for children with leukemia [9,11]. Sepsis is major barrier to improving outcome but other factors like TLS and hyperphosphatemia add to both morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

“…Management of TLS is difficult in developing countries because of limited availability of Rasburicase, hemodialysis and lack of pediatric intensive care units to handle sick children with AKI and sepsis [12] Because of the rapidity with which TLS progresses and the seriousness of common clinical consequences such as AKI, TLS is associated with significant morbidity and potential mortality. Kulkarni et al from India reported 6.8 % induction deaths due to TLS in children [9].Hyperphosphatemia being an important component of TLS can further compromise the renal functions.…”

Section: Discussionmentioning

confidence: 99%

“…The cut off values of hyperphosphatemia in children vary according to age [8]. TLS and hyperphosphatemia can lead to morbidity and mortality especially in the developing world setting [9]. There is a need for an agent which can perhaps lead to avoidance of dialysis for hyperphosphatemia and reduce cost and save lives.…”

Section: Introductionmentioning

confidence: 99%

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Sevelamer is an Effective Drug in Treating Hyperphosphatemia Due to Tumor Lysis Syndrome in Children: A Developing World Experience

Kahlon

Dinand

Yadav³

et al. 2014

Indian J Hematol Blood Transfus

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We report here a study on efficacy of sevelamer hydrochloride in treating hyperphosphatemia due to tumor lysis syndrome (TLS) in a developing world setting. Twenty one children with hyperphosphatemia due to TLS were included. All received hyper-hydration, allopurinol and sevelamer. Efficacy was assessed by decrease in serum phosphate level, calcium-phosphate product and TLS score as per Cairo Bishop definition. Four children who underwent dialysis were excluded from analysis. Among the remaining 17 patients with hyperphosphatemia, laboratory TLS was recorded in 15 patients and clinical TLS in five. Sevelamer was given according to weight, most often 400 mg twice to thrice daily. Mean phosphatemia decreased from 8.3 ± 3.0 to 6.7 ± 2.1 mg/dl within 24 h of starting sevelamer (p = 0.02), 6.0 ± 2.1 mg/dl at 48 h, 4.9 ± 1.5 mg/dl at 72 h and 4.39 ± 1.7 mg/dl at 96 h. TLS was corrected in 72 h in 14 patients, 96 h in 1 and 120 h in another patient. Mean calcium-phosphate product decreased from 63.0 ± 14.0 to 49.2 ± 9.7 mg/dl (p = 0.002) at 24 h, 46.1 ± 17.0 mg/dl at 48 h and 39.7 ± 13.5 mg/dl at 72 h. There was no mortality due to hyperphosphatemia. Sevelamer is efficacious in children with malignancy-associated hyperphosphatemia in the developing world.

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Trial Effect in Newly Diagnosed Pediatric Acute Lymphoblastic Leukemia

Kulkarni¹,

Arya²

2010

Arch Pediatr Adolesc Med

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Survival outcome in childhood ALL: Experience from a tertiary care centre in North India

Cited by 61 publications

References 39 publications

Implementation of an intensive risk‐stratified treatment protocol for children and adolescents with acute lymphoblastic leukemia in Lebanon

Implementation of an intensive risk‐stratified treatment protocol for children and adolescents with acute lymphoblastic leukemia in Lebanon

Sevelamer is an Effective Drug in Treating Hyperphosphatemia Due to Tumor Lysis Syndrome in Children: A Developing World Experience

Trial Effect in Newly Diagnosed Pediatric Acute Lymphoblastic Leukemia

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