open access

Vol 53, No 2 (2022)
Original research article
Submitted: 2021-03-30
Accepted: 2021-08-12
Published online: 2022-02-08
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Chemotherapy delays in children with acute lymphoblastic leukemia might influence the outcome of treatment

Anna Puła12, Maciej Zdunek1, Kaja Michalczyk1, Maciej Cichosz1, Wojciech Młynarski1
DOI: 10.5603/AHP.a2022.0007
·
Acta Haematol Pol 2022;53(2):141-148.
Affiliations
  1. Department of Pediatrics, Oncology and Hematology, Medical University of Łódź, Łódź, Poland
  2. Department of Hematology, Medical University of Łódź, Łódź, Poland

open access

Vol 53, No 2 (2022)
ORIGINAL RESEARCH ARTICLE
Submitted: 2021-03-30
Accepted: 2021-08-12
Published online: 2022-02-08

Abstract

Introduction: Acute lymphoblastic leukemia (ALL) is one of the most commonly occurring cancers among children with one of the highest survival rates, thanks to its very strict treatment protocol. In this paper, the impact of delays in treatment during the induction phase was assessed.

Material and methods: Retrospective single center analysis of 127 patients treated between years 2003 and 2015 was performed. Patients were categorized by their respective gender, age, leukemia variant, risk group and chemotherapy protocol used. The delays were measured using protocol milestones as reference points. The associations between treatment delay intervals and event-free survival (PFS) or overall survival (OS) were evaluated using Kaplan-Meier curves and univariate Cox proportional hazards regression models.

Results: Delays in treatment which occurred before the 8th day were associated with a 30% increase in the risk of death (p < 0.01) and a 33% increase in the risk of relapse or death (p < 0.01). The influence of delays after the 8th day was statistically insignificant. Delays were proven to have the most influence on outcome in the high-risk group, especially before the 8th day.

Conclusions: The ALL treatment protocols should be strictly followed as any delay may lead to worse patients’ survival.

Abstract

Introduction: Acute lymphoblastic leukemia (ALL) is one of the most commonly occurring cancers among children with one of the highest survival rates, thanks to its very strict treatment protocol. In this paper, the impact of delays in treatment during the induction phase was assessed.

Material and methods: Retrospective single center analysis of 127 patients treated between years 2003 and 2015 was performed. Patients were categorized by their respective gender, age, leukemia variant, risk group and chemotherapy protocol used. The delays were measured using protocol milestones as reference points. The associations between treatment delay intervals and event-free survival (PFS) or overall survival (OS) were evaluated using Kaplan-Meier curves and univariate Cox proportional hazards regression models.

Results: Delays in treatment which occurred before the 8th day were associated with a 30% increase in the risk of death (p < 0.01) and a 33% increase in the risk of relapse or death (p < 0.01). The influence of delays after the 8th day was statistically insignificant. Delays were proven to have the most influence on outcome in the high-risk group, especially before the 8th day.

Conclusions: The ALL treatment protocols should be strictly followed as any delay may lead to worse patients’ survival.

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Keywords

acute lymphoblastic leukemia, delays, oncology, hematology

About this article
Title

Chemotherapy delays in children with acute lymphoblastic leukemia might influence the outcome of treatment

Journal

Acta Haematologica Polonica

Issue

Vol 53, No 2 (2022)

Article type

Original research article

Pages

141-148

Published online

2022-02-08

Page views

233

Article views/downloads

28

DOI

10.5603/AHP.a2022.0007

Bibliographic record

Acta Haematol Pol 2022;53(2):141-148.

Keywords

acute lymphoblastic leukemia
delays
oncology
hematology

Authors

Anna Puła
Maciej Zdunek
Kaja Michalczyk
Maciej Cichosz
Wojciech Młynarski

References (16)
  1. Hunger SP, Mullighan CG. Acute lymphoblastic leukemia in children. N Engl J Med. 2015; 373(16): 1541–1552.
  2. Stary J, Zimmermann M, Campbell M, et al. Intensive chemotherapy for childhood acute lymphoblastic leukemia: results of the randomized intercontinental trial ALL IC-BFM 2002. J Clin Oncol. 2014; 32(3): 174–184.
  3. Dördelmann M, Reiter A, Borkhardt A, et al. Prednisone response is the strongest predictor of treatment outcome in infant acute lymphoblastic leukemia. Blood. 1999; 94(4): 1209–1217.
  4. Gaynon PS, Desai A, Bostrom B, et al. Early response to therapy and outcome in childhood acute lymphoblastic leukemia. Cancer. 1997; 80(9): 1717–1726, doi: 10.1002/(sici)1097-0142(19971101)80:9<1717::aid-cncr4>3.0.co;2-b.
  5. Miller DR, Coccia PF, Bleyer WA, et al. Early response to induction therapy as a predictor of disease-free survival and late recurrence of childhood acute lymphoblastic leukemia: a report from the Childrens Cancer Study Group. J Clin Oncol. 1989; 7(12): 1807–1815.
  6. Yeoh A, Collins A, Fox K, et al. Treatment delay and the risk of relapse in pediatric acute lymphoblastic leukemia. Pediatr Hematol Oncol. 2017; 34(1): 38–42.
  7. Metzger ML, Howard S, Fu L, et al. Outcome of childhood acute lymphoblastic leukaemia in resource-poor countries. Lancet. 2003; 362(9385): 706–708.
  8. Gupta S, Antillon FA, Bonilla M, et al. Treatment-related mortality in children with acute lymphoblastic leukemia in Central America. Cancer. 2011; 117(20): 4788–4795.
  9. Möricke A, Zimmermann M, Reiter A, et al. Long-term results of five consecutive trials in childhood acute lymphoblastic leukemia performed by the ALL-BFM study group from 1981 to 2000. Leukemia. 2010; 24(2): 265–284.
  10. Laughton SJ, Ashton LJ, Kwan E, et al. Early responses to chemotherapy of normal and malignant hematologic cells are prognostic in children with acute lymphoblastic leukemia. J Clin Oncol. 2005; 23(10): 2264–2271.
  11. Koka A, Saygin C, Uzunaslan D, et al. A 17-year experience with ALL-BFM protocol in acute lymphoblastic leukemia: prognostic predictors and interruptions during protocol. Leuk Res. 2014; 38(6): 699–705.
  12. Wahl SK, Gildengorin G, Feusner J. Weekend delay in initiation of chemotherapy for acute lymphoblastic leukemia: does it matter? J Pediatr Hematol Oncol. 2012; 34(1): e8–ee11.
  13. Meeske KA, Ji L, Freyer DR, et al. Comparative toxicity by sex among children treated for acute lymphoblastic leukemia: a Report From the Children's Oncology Group. Pediatr Blood Cancer. 2015; 62(12): 2140–2149.
  14. Leonard K. A European survey relating to cancer therapy and neutropenic infections: nurse and patient viewpoints. Eur J Oncol Nurs. 2012; 16(4): 380–386.
  15. Chang JE, Medlin SC, Kahl BS, et al. Augmented and standard Berlin-Frankfurt-Munster chemotherapy for treatment of adult acute lymphoblastic leukemia . Leuk Lymphoma. 2008; 49(12): 2298–2307.
  16. Shah N, Al-Ahmari A, Al-Yamani A, et al. Outcome and toxicity of chemotherapy for acute lymphoblastic leukemia in children with Down syndrome. Pediatr Blood Cancer. 2009; 52(1): 14–19.

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