Effectiveness of Modified UKALL protocols in Children with Acute Lymphoblastic Leukemia; an experience of Children Welfare Teaching Hospital.
Background:Acute Lymphoblastic Leukaemia (ALL) is the most common diagnosis in childhood cancer. Cure is possible and even likely. Aims of study: To evaluate the effectiveness of modified UKALL protocols in a setting with limited resources and to define an event free survival of Acute Lymphoblastic Leukemia in children aged 1 ‐15 years who were committed to ﬁnish treatment. Methods: This is a retrospective study that reviewed 559 children with newly diagnosed ALL between 1 and 15 years of age during the period: January 1st, 2000 to December 31st, 2009 who were committed to ﬁnish treatment protocol. All patients were treated with regimens modified from Medical Research Council protocol (United Kingdom Acute Lymphoblastic Leukemia‐ UKALL‐ protocols). The Event Free Survival (EFS) was measured using Kaplan – Meier method with a total duration of observation till December 31st 2011 (a minimum of two years post starting treatment) and data were processed and tabulated using SPSS (Statistical Package for the Social Sciences) . Results:The majority of treated children (348, 62.2%) were standard risk group; remission induction was achieved in 461(82.4%) patients. Eleven patients (1.9%) were poor responders. Death during ﬁrst 60 days from treatment was reported in 87 (15.5%) patients and death in complete remission (CR) was reported in 49 (8.7%) patients. The major presumptive causes of death were infection/sepsis followed by bleeding. Of 559 patients; 302(54%) remained in continuous complete remission with a median follow up time of 52.5 months (range from 23.9 months‐ 11.6 years). There was a significant difference in EFS between Standard Risk group (61.2%) and High Risk group (42.2%) after induction (P=0.02) and in later phases of therapy (P=0.0002). Increased relapse rate in high risk group was the reason behind the diﬀerence in EFS (P=0.0004) between two groups. Relapses were documented in 110(19.6%) patients and the bone marrow (51.8%) was the main site of relapse followed by CNS (27.2%). Conclusion:The study showed lower ALL EFS than that of recognized cancer centers.