Relapsed Childhood Acute Lymphoblastic Leukemia: A Single-Institution Experience

Abstract

Background Even though the treatment outcomes of childhood acute lymphoblastic leukemia (ALL) have improved recently, relapse of the disease still remains a challenge in developing countries. This study aims to analyze the incidence of relapse and survival rates in childhood ALL. Methods A retrospective study of 156 children with de novo ALL between 2012-2018 was conducted. Data on age, gender, relapse type, and relapse time were analyzed. Results A total of 26 (16.7%) patients experienced relapse, with a male-to-female ratio of 2.71:1. The relapse rate in the high-risk group was 1.6 times greater than that in the standard-risk group (61.5% vs. 38.5%). The median time from diagnosis to relapse was 29.3 months (38.5% in the early stage, 26.9% in the intermediate, and 34.6% in the late stage). The most common relapse site was bone marrow (38.5%), followed by the isolated central nervous system (CNS, 23.1%) and CNS plus bone marrow (23.1%); the least common site was testicle with or without bone marrow or CNS (15.2%). The median post-relapse survival time was 7.5 months. Conclusion Modification of the protocol to use escalated methotrexate dose and providing new therapies such as stem cell transplantation can improve the overall survival rates in relapsed ALL patients.

Keywords: acute lymphoblastic leukemia; relapse; treatment.

Figure 1. The correlation between relapse events and survival after relapse