Outcome of childhood acute lymphoblastic leukemia treated using the thai national protocols
Background: In recent decades, the prognosis for childhood leukemia has improved, especially for acute lymphoblastic leukemia (ALL). In Thailand, though, the survival rate for ALL is unimpressive. In 2006, standard national protocols for childhood leukemia treatment were implemented. We herein repor...
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th-mahidol.356402018-11-23T16:51:34Z Outcome of childhood acute lymphoblastic leukemia treated using the thai national protocols Panya Seksarn Surapon Wiangnon Gavivann Veerakul Thirachit Chotsampancharoen Somjai Kanjanapongkul Su On Chainansamit Chulalongkorn University Khon Kaen University Mahidol University Prince of Songkla University Queen Sirikit National Institute of Child Health Khon Kaen Regional Hospital Biochemistry, Genetics and Molecular Biology Background: In recent decades, the prognosis for childhood leukemia has improved, especially for acute lymphoblastic leukemia (ALL). In Thailand, though, the survival rate for ALL is unimpressive. In 2006, standard national protocols for childhood leukemia treatment were implemented. We herein report the outcome of the ALL national protocols and explanations behind discrepancies in outcomes between institutions. Materials and Methods: Between March 2006 and February 2008, 486 children with ALL from 12 institutions were enrolled in the Thai national protocols. There were 3 different protocols based on specific criteria: one each for standard risk, high risk and Burkitt's ALL. We classified participating centers into 4 groups of institutions, namely: medical schools in Bangkok, provincial medical schools, hospitals in Bangkok and provincial hospitals. We also evaluated supportive care, laboratory facilities in participating centers, socioeconomics, and patient compliance. Overall and event-free survival were determined for each group using the Kaplan Meier method. Statistical differences were determined using the log-rank test. Previous outcomes of Thai childhood ALL treatment between 2003 and 2005 served as the historic control. Results: Five-year overall survival of ALL treated using the Thai national protocol was 67.2%; an improvement from the 63.7% of the 12-institute historical control (p-value=0.06). There were discrepancies in event-free survival of ALL between centers in Bangkok and up-country provinces (69.9% vs 51.2%, p-value <0.01). Socioeconomics and patient compliance were key elements in determining the outcome (65.5% vs 47.5%, 59.4% vs 42.9%) (p-value < 0.02). Conclusions: Implementation of standard national protocols for childhood leukemia in Thailand did not significantly improve the outcome of ALL. Factors leading to better outcomes included (a) improvement of treatment compliance (b) prevention of treatment abandonment and (c) financial support to the family. 2018-11-23T09:51:34Z 2018-11-23T09:51:34Z 2015-01-01 Article Asian Pacific Journal of Cancer Prevention. Vol.16, No.11 (2015), 4609-4614 10.7314/APJCP.2015.16.11.4609 15137368 2-s2.0-84936972892 https://repository.li.mahidol.ac.th/handle/123456789/35640 Mahidol University SCOPUS https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84936972892&origin=inward |
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Biochemistry, Genetics and Molecular Biology Panya Seksarn Surapon Wiangnon Gavivann Veerakul Thirachit Chotsampancharoen Somjai Kanjanapongkul Su On Chainansamit Outcome of childhood acute lymphoblastic leukemia treated using the thai national protocols |
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Background: In recent decades, the prognosis for childhood leukemia has improved, especially for acute lymphoblastic leukemia (ALL). In Thailand, though, the survival rate for ALL is unimpressive. In 2006, standard national protocols for childhood leukemia treatment were implemented. We herein report the outcome of the ALL national protocols and explanations behind discrepancies in outcomes between institutions. Materials and Methods: Between March 2006 and February 2008, 486 children with ALL from 12 institutions were enrolled in the Thai national protocols. There were 3 different protocols based on specific criteria: one each for standard risk, high risk and Burkitt's ALL. We classified participating centers into 4 groups of institutions, namely: medical schools in Bangkok, provincial medical schools, hospitals in Bangkok and provincial hospitals. We also evaluated supportive care, laboratory facilities in participating centers, socioeconomics, and patient compliance. Overall and event-free survival were determined for each group using the Kaplan Meier method. Statistical differences were determined using the log-rank test. Previous outcomes of Thai childhood ALL treatment between 2003 and 2005 served as the historic control. Results: Five-year overall survival of ALL treated using the Thai national protocol was 67.2%; an improvement from the 63.7% of the 12-institute historical control (p-value=0.06). There were discrepancies in event-free survival of ALL between centers in Bangkok and up-country provinces (69.9% vs 51.2%, p-value <0.01). Socioeconomics and patient compliance were key elements in determining the outcome (65.5% vs 47.5%, 59.4% vs 42.9%) (p-value < 0.02). Conclusions: Implementation of standard national protocols for childhood leukemia in Thailand did not significantly improve the outcome of ALL. Factors leading to better outcomes included (a) improvement of treatment compliance (b) prevention of treatment abandonment and (c) financial support to the family. |
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Chulalongkorn University |
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Chulalongkorn University Panya Seksarn Surapon Wiangnon Gavivann Veerakul Thirachit Chotsampancharoen Somjai Kanjanapongkul Su On Chainansamit |
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Article |
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Panya Seksarn Surapon Wiangnon Gavivann Veerakul Thirachit Chotsampancharoen Somjai Kanjanapongkul Su On Chainansamit |
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Panya Seksarn |
title |
Outcome of childhood acute lymphoblastic leukemia treated using the thai national protocols |
title_short |
Outcome of childhood acute lymphoblastic leukemia treated using the thai national protocols |
title_full |
Outcome of childhood acute lymphoblastic leukemia treated using the thai national protocols |
title_fullStr |
Outcome of childhood acute lymphoblastic leukemia treated using the thai national protocols |
title_full_unstemmed |
Outcome of childhood acute lymphoblastic leukemia treated using the thai national protocols |
title_sort |
outcome of childhood acute lymphoblastic leukemia treated using the thai national protocols |
publishDate |
2018 |
url |
https://repository.li.mahidol.ac.th/handle/123456789/35640 |
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1763490511845326848 |