INITIAL TREATMENT DELAY IN NEWLY DIAGNOSED CHILDHOOD ALL AND INDUCTION REMISSION FAILURE IN DR SARDJITO HOSPITAL, YOGYAKARTA, INDONESIA
Irenne Purnama,Pudjo Hagung Widjajanto,Ignatius Purwanto
Pediatric Hematology Oncology Division Dr Sardjito General Hospital Faculty of Medicine Public Health and Nursing Universitas Gadjah Mada Yogyakarta Indonesia Pediatric Hematology Oncology Division Dr Sardjito Hospital Faculty of Medicine Public Health and Nursing Universitas Gadjah Mada Yogyakarta Indonesia
Background : Initial treatment delayed in childhood Acute Lymphoblastic Leukemia (ALL) has been a problem that encountered after diagnosis. We studied the effect of delayed initial treatment to remission achievement at the end of induction phase. It was proven that longer interval from diagnosis to treatment was associated with worse complete remission and overall survival in subjects less than 60 years with AML. Nevertheless this effect on children with ALL had not been fully investigated.
Material : A retrospective study was conducted on childhood (<15 years) ALL admitted to our center during 1999-2016. We abstracted data regarding date of the diagnosis and date when chemotherapy started , baseline characteristics and remission achievement at the end of induction phase. Our inclusion criteria were age < 15 years, no previous chemotherapy administration or treatment was started 0-30 days after diagnosis.
Results : Of 1049 newly diagnosed ALL patients, 833 (79.4%) met our inclusion criteria. The median of time interval from diagnosis to treatment was 2.96 days (0-30 days) and 241 of 833(28.9%) patients underwent delayed treatment more than 3 days after diagnosis. Of this delayed patients, 72 (29.9%) had remission failure due to resistant disease (17 or 9.1%), death (20 or 27.7%) and drop out (35 or 48.6%), respectively. There was no association between initial treatment delayed and induction remission failure (p =0.933) or resistant disease (p=0.414).
Conclusions : There is no significant effect of delay chemotherapy initiation in newly diagnosed ALL patients to remission failure and resistant disease. This result could came because the time interval criteria for delayed treatment is short (3 days) or other factors in our setting