ABSTRACT
Background & objectives: Survival in paediatric acute lymphoblastic leukaemia (ALL) in lower/middle income countries continues to lag behind outcomes seen in high-income countries. Socio-economic factors and distance of their residence from the hospital may contribute to this disparity. This study was aimed at identifying the impact of these factors on outcome in childhood ALL. Methods: In this retrospective study, file review of children with ALL was performed. Patients were treated with the modified United Kingdom (UK) ALL-2003 protocol. Details of socio-economic/demographic factors were noted from a web-based patients' database. Modified Kuppuswamy scale was used to classify socio-economic status. Results: A total of 308 patients with a median age of five years (range: 1-13 yr) were studied. Patients belonging to upper, middle and lower SE strata numbered 85 (28%), 68 (22%) and 155 (50%). Nearly one-third of the patients were underweight. There was no treatment abandonment among children whose mothers were graduates. Neutropenic deaths during maintenance therapy were lower in mothers who had passed high school. In patients who survived induction therapy, the five year event-free survival (EFS) of upper SE stratum was significantly better 78.7�9 vs. 59�2 and 58.1�6 per cent in middle and lower strata (P =0.026). Five year overall survival was higher in the higher SE group; being 91.2�5, 78.3�6 and 78.8�9 per cent (P =0.055) in the three strata. Survival was unaffected by a distance of residence from treating centre or rural/urban residence. High-risk and undernourished children had a greater hazard of mortality [1.80 (P =0.015); 1.98 (P =0.027)]. Interpretation & conclusions: Our findings showed that higher socio-economic status contributed to superior EFS in children with ALL who achieved remission. Undernutrition increased the risk of mortality.
ABSTRACT
Objective To analyze the clinic efficacy of allogeneic hematopoietic stem cell transplantation(alloHSCT) for children with myelodysplastic syndromes(MDS) and to investigate the possible prognostic factors.Methods Eighteen children with MDS who underwent allo-HSCT at Shanghai Children's Medical Center Affiliated to Medical School of Shanghai Jiaotong University between Nov.2007 and Aug.2011 were retrospectively reviewed.Seven cases received transplantation before Dec.2009 and 11 cases later.Results Up to the follow-up end point,6 cases died,and among them 3 cases died of relapse and 3 cases died of related treatment after transplantation.The 2-year disease free survival(DFS) rate of all patients was(65.0 ± 11.7)％.The 2-year DFS rate was significantly different between the group receiving transplantation before Dec.2009 and the group receiving transplantation later[(28.6 ± 17.1)％ vs (90.9 ± 8.7) ％,P =0.01].Patients treated by regimen of busulfan/cyclophosphamide (BUCy) had a significant higher 2-year DFS rate compared with other treatment regimens [(83.3 ± 10.8) ％ vs (25 ± 20.4) ％,P =0.035].The selected pretreatment regimen showed a significant difference between 2 groups in the different transplantation periods,and the pretreatment regimen of BUCy was more frequently used in both groups after Dec.2009 (P =0.004).Conclusions Allo-HSCT is an effective treatment strategy for children with MDS and the pretreatment regimen of BUCy is suitable for those patients.The experience accumulation about transplantation and the improvement of supportive medical care have substantially improved HSCT outcome and reduced the treatment-related mortality.