Abstract
Introduction Acute leukemia (AL) is among the most common treatable cancers in childhood but many
children are forced to abandon therapy.
Objective We have explored reasons for treatment abandonment through this study.
Materials and Methods Retrospective analysis from an ongoing registry data of childhood AL patients, where
all newly diagnosed AL patients of ≤18 years of age (June 2014–November 2017) were
included. Patients >18 years of age, having any history of treatment of AL outside
our institute, and/or patients with relapsed AL were excluded. The primary outcome
of the study was treatment abandonment rate.
Results A total of 710 AL patients were included in the study, average distance traversed
to reach the hospital being 161.66 km. Most children were aged 1 to 10 years (49.4%,
n = 351), followed by >10 to 18 years (46.6%, n = 331), and ≤1 year age (3.9%, n = 28). The commonest symptoms were fever (67.4%), pallor (38.6%), bleeding (11.5%),
bone pain (13.8%), neck swellings (14.9%), and, rarely, testicular swellings or Superior
vena cava (SVC) syndrome (1.1%). A high abandonment rate was noted prior to leukemia
subtyping (35.2%, n = 250) mostly among males 62% (n = 155) and the 1- to 10-year group 55.6% (n = 139). A total of 460 (64.8%) patients were subsequently subcategorized by immunophenotyping.
Precursor B-cell (Pre-B) Acute Lymphoblastic Leukemia (ALL) in 307 (43.2%) patients
was the commonest subtype, followed by early Pre-B ALL (Pro-B ALL) in 10 (1.4%), T-cell
ALL (T-ALL) in 51 (7.1%), Acute Myeloid Leukemia (AML) in 45 (6.3%), Acute Promyelocytic
Leukemia (APML) in 28 (3.9%), and Mixed Phenotypic Acute Leukemia (MPAL) in 19 (2.6%).
Conclusion The most common group of patients was aged 1 to 10 years (median age: 5 years). An
abandonment rate of 35.2% was seen prior to complete diagnostic workup. The reason
for this high abandonment, despite good disease prognosis, is a relevant social and
health issue, and needs further evaluation. The problems discussed in this study are
relevant to lower-income families and areas where health care is not easily accessible.
The government agencies, nongovernment organizations and society would need to work
together to overcome these issues.
Keywords
childhood acute leukemia - treatment abandonment - incidence
