الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Acute leukemia (AL) is considered the most common form of pediatric cancer. Nowadays, it is curable on the majority of pediatric patients, with achievement of 95% long-term remission. The are many sub-types of AL in children but the most common sub-types are Acute Lymphoblastic Leukemia (ALL) and Acute Myeloid Leukemia (AML). We aimed to show the epidemiology and treatment outcome of children with AL treated in our center.
This was a retrospective study. The available data have been retrieved from medical files of children newly diagnosed with AL during the period from 1st January 2013 to 31st December 2018 at Alexandria University Children’s Hospital, which is considered to be a large tertiary care center in northern Egypt. The demographic, initial clinical, and laboratory data were collected, as well as the treatment protocol and outcome of included patients.
A total of 409 patients were identified during the study period, at which 94 patients have been transferred to a central children’s cancer hospital in Cairo, and 315 were treated and was further analyzed. The patients’ age ranged from 2.0 to 288 months, the majority of patients were from age group of 1-10 years, 19 (6%) patients were >10 years of age, and 13 (4.1%) patients were <1 year of age. One hundred sixty eight (53.3%) patients were males, while females represented 147 (46.7%) patients. two hundred fifty seven (81.6%) patients had ALL and 58 (18.4%) patients had AML. At time of presentation, the median total leucocytic count was 12.0 x103/µL, ranging from 0.2 - 989 x103/µL; 37 (11.7%) patients had hyperleukocytosis.
from 2013 to mid 2017, ALL patients were treated according to modified CCG-1991 standard risk protocol and CCG-1961 high-risk protocol, while from mid 2017 Total XV protocol starting to be used. AML patients were treated according to MRC 12 protocol. Regarding patients’ outcome, 128 (49.8%) of ALL patients were in remission after treatment, 56 (21.8%) were on treatment, 57 (22.2%) have died, 9 (3.5%) died after relapse, 6 (2.3%) relapse on treatment and 1 (0.4%) patient had a therapy-induced AML. Among the AML patients, 21 (36.2%) patients were in remission after end treatment, 3 (5.2%) still on treatment, 27 (46.6%) died, 6 (10.3%) died after relapse, and only one (1.7%) patient has been lost to follow up, which significantly worse outcome than ALL patients, (p<0.001*). Only 6.7% of patients relapsed over the study period; hematological relapse was the most common type of relapse (71%).
Using the Kaplan-Meier survival curve, the 3-years overall survival for all treated patients was 70.4%. Early deaths were marked among infant leukemia as well as AML patients, and the most common cause of death among all treated patients was infections. The 3-years overall survival for ALL patients was 73.2% while 43.9% in AML patients (p<0.001*). Among ALL patients, B-ALL had a higher 3-year event-free survival (78.4%) in comparison to T-ALL (62.5%), p = 0.035.