Survival and Treatment Outcomes of Childhood Acute Lymphoblastic Leukemia in a Low-Middle Income Country: A Single-Center Experience in West Java, Indonesia

Figures & data

Figure 1 Flow chart of subject selection.

Abbreviations: ALL, acute lymphoblastic leukemia; ALL-L3, acute lymphoblastic leukemia with bone marrow morphology showed L3.

Table 1 Demographical and Clinical Characteristics of Subjects

Characteristic	N (%)
1. Gender
Male	72 (52.2)
Female	66 (47.8)
2. Age at diagnosis (years)
1–10	98 (71.0)
>10–<18	40 (29.0)
3. Nutritional status
Normal	73 (54.5)
Mild malnutrition	9 (6.7)
Moderate malnutrition	44 (32.8)
Severe malnutrition	8 (6.0)
4. Leucocyte
<50 x10^3/uL	100 (78.1)
≥50 x10^3/uL	28 (21.9)
5. Splenomegaly
Yes	59 (58.4)
No	42 (41.6)
6. Hepatomegaly
Yes	46 (44.7)
No	57 (55.3)
7. Mediastinal mass
Yes	1 (1.0)
No	95 (99.0)
8. Risk Stratification
HR	87 (64.0)
SR	49 (36.0)
9. Evaluation after the induction phase
Failure to respond	7 (11.5)
Remission	54 (88.5)
10. CNS involvement
Negative	85 (92.4)
Positive	7 (7.6)
11. Outcome
Relapse	35 (55.5)
Remission	28 (44.5)

Abbreviations: HR, high risk; SR, standard risk; CNS, central nervous system.

Table 2 Association Between Demographical and Clinical Characteristics to the Outcome and Hazard Ratio to Overall Survival (OS)

Characteristics	Outcome		p-value*	Univariate Analysis
	Survive	Death		Hazard Ratio for Death (CI 95%)	p-value
1. Gender			0.267
Male	33 (53.2)	29 (46.8)		1.16 (0.69–1.94)	0.57
Female	25 (43.1)	33 (56.9)
2. Age at diagnosis (years)			0.140
1–10	47 (52.2)	43 (47.8)
>10–<18	11 (36.7)	19 (63.3)		1.72 (0.99–1.94)	0.055
3. Nutritional status			0.825
Normal	31 (50.8)	30 (49.2)
Mild malnutrition	3 (50)	3 (50.0)		1.82 (0.54–6.04)	0.340
Moderate malnutrition	17 (41.5)	24 (58.5)
Severe malnutrition	4 (50.0)	4 (50.0)
4. Leucocyte			0.468
<50 x10^3/uL	41 (48.2)	44 (51.8)
≥50 x10^3/uL	10 (40.0)	15 (60.0)	0.641	2.44 (1.31–4.52)	0.005
5. Splenomegaly
Yes	25 (49.0)	26 (51.0)		1.05 (0.56–1.95)	0.881
No	20 (54.1)	17 (45.9)	0.408
6. Hepatomegaly
Yes	19 (46.3)	22 (53.7)	1.00**	%1.%2 (0.56–1.85)	0.969
No	27 (55.1)	22 (44.9)
7. Mediastinal mass
Yes	0	1	0.004*	1.53 (0.21–11.33)	0.676
No	32 (41.6)	45 (58.4)
8. Risk Stratification
HR	28 (38.4)	45 (61.6)	0.045**	0.67 (0.43–1.04)	0.077
SR	30 (65.2)	16 (34.7)
9. Evaluation after the induction phase
Failure to respond	1 (14.3)	6 (85.7)	1.00*	4.00 (1.43–11.15)	<0.008
Remission	29 (58.0)	21 (42.0)
10. CNS involvement
Positive	3 (42.9)	4 (57.1)		0.54 (0.19–1.54)	<0.250
Negative	29 (39.7)	44 (60.3)

Notes: *Chi-square test; **Exact fisher test.

Abbreviations: HR, high risk; SR, standard risk; CNS, central nervous system.

Table 3 Multivariate Cox Regression Analysis

Variable	β	SE (B)	p-value	Hazard Ratio Adjusted (CI 95%)
Initial model:
Age at diagnosis (≥10–18 years)	−0.847	0.884	0.338	0.43 (0.08–2.42)
Initial leucocyte count (≥50x10^3/uL)	0.718	0.556	0.197	2.05 (0.69–6.10)
Risk stratification (HR)	0.275	0.382	0.471	1.32 (0.62–2.78)
CNS involvement (positive)	−1.543	1.265	0.222
Evaluation after induction (failure)	1.806	0.676	0.008	6.09 (1.62–22.90)
End model:
Evaluation after induction (failure)	1.541	0.534	0.004	4.67 (1.64–13.29)

Abbreviations: CNS, central nervous system; SE, standard error; HR, high risk; CI, confidence interval.

Figure 2 Kaplan–Meier curves of probable cumulative OS and EFS.

Figure 3 Kaplan–Meier curves of probable OS and EFS SR and HR risk stratification group.

Abbreviations: SR, standard risk; HR, high risk.