Relapse-free Rate with Childhood Acute LymphoblasticLeukemia Treated under the Thai National Protocol


Background: The standard national protocol for treatment of acute lymphoblastic leukemia (ALL) in childrenwas implemented in 2006. A systematic evaluation of the treatment outcome is needed. This study examined therelapse-free survival among childhood ALL cases treated with this protocol and related factors. Materials and
Methods: A descriptive study was conducted in children aged between 0-15 years, newly diagnosed with ALLbetween March 2006 and March 2011 at Srinagarind Hospital, Department of Pediatrics, Faculty of Medicine,Khon Kaen University. The patients were treated on the basis of stratified risk as per the Thai national protocol.Data were compiled from the hospital records. The Kaplan-Meier method was used to describe relapse-freesurvival and the Cox proportional hazard model to investigate the associated factors.
Results: Of the 103 childrenrecruited, 86 (83.5%) achieved complete remission. The total follow-up time was 3132.5 person-months. Eighteen(20.9%) relapsed. The incidence density was 0.6 per 100 person-months (95%CI: 0.4, 0.9). The respectiverelapse-free rates at 1, 3 and 5 years were 93.0% (95%CI: 85.1, 96.8), 84.5% (95%CI: 74.0, 90.9) and 64.1%(95%CI: 45.6, 77.8). A factor associated with the relapse-free rate was age under 1 year (HR=6.0; 95%CI: 1.1,33.8).
Conclusions: The rate of being relapse-free in ALL children treated under the Thai national protocolat Srinagarind Hospital was better than with former protocols; however, it is still not as good as in developedcountries. Further review of the treatment approach of ALL is needed.