The comparison of outcome and cost of three protocols for childhood non-high risk acute lymphoblastic leukemia in China

Abstract

Objective: To compare the outcome and treatment cost of three protocols for childhood non-high risk acute lymphoblastic leukemia (ALL), and evaluate the feasibility of less intensive treatment protocol for low income families.

Methods: Two hundred forty-three children were newly diagnosed ALL in a university hospital from May 1999 to August 2006. Three protocols were offered to the patients: China-98 protocol, or modified ALLIC BFM2002 protocol, or an in-house Reduced Intensity Protocol (or also known as Economic Protocol).

Results: Among 243 patients, 19 abandoned treatment, 3 transferred to other hospitals, 48 were high-risk and were treated with the high risk protocol, and 4 had mature B-ALL. A total of 169 cases were enrolled on non-high risk protocols: 46 treated on China-98 protocol, 73 on modified ALLIC BFM2002 and 50 from low income families on Economic Protocol. The event-free survival (EFS) at 4 years was 80.4% (95%CI, 68.8-92.2%), 83.5% (95%CI, 73.5-93.5%), and 72.8% (95%CI, 59.3-86.3%) for China-98 protocol, modified ALLIC BFM2002, and Economic Protocol respectively. The hospitalization costs (range and median) were significantly different between protocols: US$ 8,700-25,500 (12,500), US$ 6,900-16,400 (9,900), US$ 3,100-6,800 (4,300) for China-98 protocol, modified ALLIC BFM2002, and Economic Protocol respectively.

Conclusion: This report from China has systematically reviewed the outcome and costs of protocols for ALL having different dose intensity. The reduced intensity protocol appears to achieve reasonable EFS (72.8% at 4 years) for non-high risk ALL at a much lower cost. This is especially important for low income families in developing countries.